Employee Information/Update @Superior KC

Employee Information Sheet
Superior Home Health Services LLC Kansas MO

4380 N Oak Trafficway Suite 204 Kansas City, Mo 64116

Phone # 816-382-3405 Fax is 816-382-3405

Superior314.com
Job location: *
Job title: *
CONSUMER NAME *

First Name Last Name
EMPLOYEE NAME *

First Name Last Name
Employee Code *
STREET *
City *
State *
ZIP *
Phone Number *
Emergency Contact Home *
Phone Number *
Social Security # *
Date of Birth

Month Day Year
Hire Date

Month Day Year
Hourly Rate *
Salary Rate *
Other Rate *
Marital status (select one) *
If married note if spouse work *
Number of dependents *
Federal *
State *
Additional Federal tax withheld *
Additional state tax withheld *
City Tax *
Banking information Please include a voided check for direct deposit
Routing number *
Account number *
Please Sign and Date verifying all information is correct. *

Clear
Date *

Month Day Year
Note Changes
Should be Empty: