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Employee Information Form

Employee Information Form

EMPLOYEE INFORMATION FORM

[Employer Name]

Hire Date: [Hire Date]

Form Completed: [Form Date]

This form contains confidential employee information. Store securely in the employee's personnel file, separate from medical records.

SECTION 1 — PERSONAL INFORMATION

Full Legal Name: [Employee Name]

Preferred Name: [Preferred Name]

Date of Birth: [Date Of Birth]

Home Address: [Home Address]

State of Work: [Work State]

Phone: [Personal Phone]

Personal Email: [Personal Email]

SECTION 2 — EMPLOYMENT DETAILS

Job Title: [Job Title]

Department: [Department]

Direct Supervisor: [Supervisor Name]

Employment Type: [Employment Type]

FLSA Classification: [FLSA Classification]

SECTION 3 — PAYROLL INFORMATION

Pay Frequency: [Pay Frequency]

Pay Delivery: [Direct Deposit Preference]

Note: Employees electing direct deposit must complete a separate Direct Deposit Authorization form and provide a voided check or bank letter. Employee must also complete Form W-4 (Federal Tax Withholding) and applicable state withholding form.

SECTION 4 — EMERGENCY CONTACT

Emergency Contact: [Emergency Contact Name]

Relationship: [Emergency Contact Relationship]

Phone: [Emergency Contact Phone]

SECTION 5 — I-9 EMPLOYMENT ELIGIBILITY NOTICE

All employees must complete USCIS Form I-9 (Employment Eligibility Verification) on or before their first day of work for pay. The employee must complete Section 1 on Day 1. The employer must complete Section 2 within three business days of the employee's first day. Original, unexpired identity and work authorization documents are required. The Company does not discriminate in the I-9 process based on citizenship, national origin, or immigration status.

EMPLOYEE CERTIFICATION

I certify that the information provided on this form is complete and accurate to the best of my knowledge. I agree to promptly notify HR of any changes to my personal information, emergency contact, or employment status.

Employee Signature: _______________________________ Date: _______________

Printed Name: [Employee Name]

HR / Onboarding Coordinator: _______________________________ Date: _______________

Employee

________________

Signature

HR Representative

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Employee Information Form?

An Employee Information Form in the United States captures the structured information needed to complete the process it supports.

Several federal statutes drive the core data collection requirements. The Internal Revenue Code requires employers to collect IRS Form W-4 (Employee's Withholding Certificate) from each new hire to establish the correct federal income tax withholding rate. Regulation at 26 C.F.R. § 31.3402(f)(2)-1 requires employees to furnish a W-4 before or on the first day of work. The Immigration Reform and Control Act (IRCA), 8 U.S.C. § 1324a, requires all employers to verify employment eligibility by completing Form I-9 no later than the first day of work for pay. The Fair Labor Standards Act (FLSA), 29 U.S.C. § 211(c), and its implementing regulations at 29 C.F.R. § 516 require employers to maintain accurate payroll records including employee name, Social Security number, address, and work schedule for at least three years.

State new hire reporting laws add an independent requirement. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 42 U.S.C. § 653a, requires employers to report each new hire to the state's new hire registry within 20 days of the date of hire (or the first paycheck date). The state registry uses this information to enforce child support orders. The Employee Information Form provides the underlying data — employee name, address, Social Security number, and employer EIN — required for new hire reporting.

The Americans with Disabilities Act (ADA), 42 U.S.C. § 12112(d), and the Genetic Information Nondiscrimination Act (GINA), 42 U.S.C. § 2000ff, impose strict limitations on the medical and health information employers may collect from employees. The ADA prohibits pre-offer medical inquiries and limits post-offer, pre-employment medical examinations. GINA prohibits employers from requesting, requiring, or purchasing genetic information, including family medical history. An Employee Information Form that requests information about disabilities, medical conditions, or family health history before a conditional offer of employment violates both statutes.

The Employee Information Form is distinct from Form I-9, Form W-4, and benefits enrollment forms — but works in conjunction with all of them. Best practice is to use the Employee Information Form to capture general personal, contact, and payroll routing information, while using the federally mandated forms (I-9, W-4, state W-4 equivalents) as separate, standalone documents in the onboarding packet.

When Do You Need a Employee Information Form?

US employers need an Employee Information Form at specific points in the employment lifecycle, with new hire onboarding as the primary context.

Every new hire — whether full-time, part-time, temporary, or seasonal — must complete an Employee Information Form before the first paycheck is issued. The form is required to establish federal and state income tax withholding, set up direct deposit, create the payroll record required under the FLSA and state wage payment laws, designate an emergency contact, and gather the personal data needed for benefits enrollment and new hire reporting under PRWORA.

Relocation or address changes require employees to update the Employee Information Form to maintain accurate payroll, W-2, and emergency contact records. Employers must update payroll records promptly when an employee moves to a different state, because multi-state tax withholding obligations arise when an employee's state of residence differs from the state where they work.

Name changes — following marriage, divorce, or a legal name change — require updating the Employee Information Form so that payroll records, W-2 forms, and benefit plan records reflect the employee's current legal name. Discrepancies between payroll records and Social Security Administration records can trigger SSA no-match letters and FICA reconciliation issues.

Direct deposit changes require a new authorization entry on the Employee Information Form or a standalone direct deposit authorization form. Under the Electronic Fund Transfer Act (EFTA), 15 U.S.C. § 1693, employers who pay wages by direct deposit must obtain the employee's voluntary written authorization. Several state wage payment laws — including California Labor Code Section 213, New York Labor Law Section 192, and Texas Payroll Code Section 20.082 — regulate direct deposit and require employer compliance with employee authorization requirements.

Annual audit and verification: HR departments should verify Employee Information Form data annually — particularly emergency contacts, beneficiary designations, and tax withholding — as personal circumstances change. An outdated emergency contact or incorrect tax withholding can create significant practical and compliance problems.

What to Include in Your Employee Information Form

A complete US Employee Information Form must collect the following categories of information to satisfy employer compliance obligations and operational needs.

Personal identification fields must capture the employee's full legal name (first, middle, and last as shown on Social Security card), any preferred name or nickname, date of birth (for benefits eligibility verification and I-9 age verification), and Social Security number. The SSN is required for IRS W-2 reporting (26 C.F.R. § 31.6051-1), FICA tax withholding, new hire reporting under PRWORA, and benefits plan administration. Employers must protect SSNs under applicable state privacy laws, including California Civil Code Section 1798.85 (prohibiting public display) and similar statutes in New York, Texas, and other states.

Contact information fields must collect the employee's current residential address (street, city, state, ZIP), mailing address if different, personal phone number (mobile and/or home), and personal email address. The residential address is critical for new hire reporting, W-2 mailing, state income tax withholding determination, and state-specific employment law applicability.

Employment classification fields should capture the employee's job title, department, reporting manager, hire date, employment type (full-time, part-time, temporary, seasonal), FLSA classification (exempt or non-exempt), and scheduled hours per week. The FLSA classification determines overtime entitlement, and the hire date establishes the start of waiting periods for benefits, I-9 verification deadlines, and FMLA eligibility calculation.

Tax withholding fields must capture the employee's W-4 elections — filing status (single/married filing separately, married filing jointly, or head of household), multiple jobs adjustment, dependent credits, other income deductions, additional withholding amount, and exemption claim — per the 2020 revised Form W-4. State W-4 equivalent forms (such as California DE-4, New York IT-2104, or Illinois IL-W-4) must be collected for employees working in states with income tax. If an employee fails to complete a W-4, the employer must withhold as single with no adjustments per IRS Publication 15.

Payroll and direct deposit fields must capture the employee's preferred payment method (check or direct deposit), and for direct deposit: the bank name, ABA routing number, account number, and account type (checking or savings). The form must include an authorization statement confirming the employee voluntarily authorizes electronic payment under the EFTA. For split deposits, multiple account entries are needed.

Emergency contact fields must capture at least one emergency contact's full name, relationship to the employee, primary and alternate phone numbers, and authorization to contact in an emergency. Employers may not use emergency contact information for other purposes (such as debt collection or benefit enrollment) without the employee's separate consent.

Data retention notice: Employee Information Forms are personnel records subject to retention requirements under the FLSA (3 years for payroll records), ADEA (3 years), and state law — California Labor Code Section 1198.5 requires 3-year retention after termination; New York requires 6 years for payroll records. The form should note that information is collected for employment-related purposes only and is subject to the employer's data security and privacy policies.

Sources & Citations

Statutory citations link to official government sources.

  1. 8 U.S.C. § 1324aUS – Cornell LII
  2. 29 U.S.C. § 211US – Cornell LII
  3. 42 U.S.C. § 653aUS – Cornell LII
  4. 42 U.S.C. § 12112US – Cornell LII
  5. 42 U.S.C. § 2000fUS – Cornell LII
  6. 15 U.S.C. § 1693US – Cornell LII
  7. 26 C.F.R. § 31.3402US – eCFR
  8. 29 C.F.R. § 516US – eCFR
  9. 26 C.F.R. § 31.6051US – eCFR
  10. Americans with Disabilities ActUS – Cornell LII
  11. ADAUS – Cornell LII
  12. ADEAUS – Cornell LII
  13. FMLAUS – Cornell LII
  14. Fair Labor Standards ActUS – Cornell LII
  15. FLSAUS – Cornell LII

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Employee Information Form (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/hr-forms/employee-information-form

MLA

"Employee Information Form (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/hr-forms/employee-information-form.

BibTeX
@misc{formslegal-employee-information-form,
  author       = {{Forms Legal}},
  title        = {Employee Information Form (United States)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/usa/employment/hr-forms/employee-information-form}},
  note         = {Free legal document template. Based on Fair Labor Standards Act (29 U.S.C. §201-219)}
}

Frequently Asked Questions

Based on Fair Labor Standards Act (29 U.S.C. §201-219) — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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