Alterity New Hire Step 1 of 5 20% Contact InformationName* First Middle Initial Last NicknameWhat name would you prefer for clients, colleagues and your email address? (e.g., Ally for Alexandra, Zach for Zachary)Other Namese.g., maiden nameMobile Number*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment EligibilityAlterity is required to obtain a completed Form I-9 for every new employee. Federal and state laws require employers to report new hires. Refer to the Employment Eligibility Verification Employee Information Sheet for more information.Date of Birth* Date Format: MM slash DD slash YYYY Citizenship Status*A citizen of the United StatesA noncitizen national of the United StatesA lawful permanent residentAn alien authorized to work until...Alien Registration or USCIS Number*Number Type*Is the above number an Alien Registration Number or a USCIS Number?Alien Registration NumberUSCIS NumberSocial Security Number*Document(s) for Form I-9*What form(s) of identification can you bring with you, on or before your first day of work?Drivers License and Social Security CardUS PassportOtherUS Passport - Number*US Passport - Expiration Date* Date Format: MM slash DD slash YYYY Drivers License - Number*Drivers License - State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDrivers License - Expiration* Date Format: MM slash DD slash YYYY Document(s) for Identification*Please provide us with the Document Title, Issuing Authority, Document Number and Expiration Date (if any) for the document(s) that you will be providing for Employment Eligibility Verification. Emergency ContactsEmergency Contact* First Last Relation*SpousePartnerMotherFatherSisterBrotherSonDaughterFriendOtherEmergency Contact Phone*Secondary Emergency Contact First Last Secondary RelationSpousePartnerMotherFatherSisterBrotherSonDaughterFriendOtherSecondary Contact Phone Payroll Info and TaxesAlterity will provide you with IRS Form W-4 (pdf) to sign on your first day of employment. The following information will help us to begin working on your payroll.Marital Status**Head of household only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.Single or Married filing separatelyMarried filing jointlyHead of householdBank Name*Bank Routing Number*Bank Account Number*Bank Account Type*CheckingSavingsSecond Bank Account*Would you like to split your pay between two bank accounts?YesNoSecond Bank NameSecond Bank Routing NumberSecond Bank Account NumberSecond Bank Account TypeCheckingSavingsSecond Bank SplitHow would you like to split your pay into the two accounts? For example, "First $500 to Primary, Balance to Second" Equal Employment OpportunityAlterity does not discriminate based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability and genetic information (including family medical history). We provide equal pay for equal work. As a small business employer, Alterity is not required to report data about the ethnicity, race and gender of our workforce to the government. However, the following information is requested to better understand our progress in diversity. In the future, we may be required to report this information. Self-reporting GenderFemaleMaleRace / EthnicityHispanic or LatinoWhiteBlack or African AmericanHawaiian or Pacific IslanderAsianAmerican Indian or Alaska NativeTwo or More RacesUS VeteranNoYesMilitary StatusNon-MilitaryActiveReserveDisabledNoYesDescription of Disability