Powered by Service Veteran and Linemen Owned Contractor Application Form Please fill out the following information. Step 1 of 5 20% CommentsThis field is for validation purposes and should be left unchanged.Full Legal Name(Required) First Middle Last Physical Address(Required) Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) GenderSelect GenderMaleFemaleOtherUpload Drivers License(Required) Drop files here or Select files Max. file size: 8 MB. Drivers License Number(Required) Union InformationUpload Union Ticket(Required) Drop files here or Select files Max. file size: 8 MB. Union Ticket Number(Required)Upload Medical Card(Required) Drop files here or Select files Max. file size: 8 MB. Medical Card Expiration Date(Required) Month Day Year W4 - Employee’s Withholding CertificateDo you qualify and wish to be exempt from federal taxes?(Required) Yes No When you file as exempt from federal withholding, the government will stop withholding federal income taxes from your paychecks. However, you can't claim exempt status just because you feel like it. You can only file as exempt for the tax year if both of the following are true: - You owed no federal income taxes the previous year; and - You expect to owe no federal income taxes for the current year.(Required) I agree and acknowledge what it means to be exempt from federal taxesWhen you file as exempt from federal withholding, the government will stop withholding federal income taxes from your paychecks. However, you can't claim exempt status just because you feel like it. You can only file as exempt for the tax year if both of the following are true: - You owed no federal income taxes the previous year; and - You expect to owe no federal income taxes for the current year.Step 1: Enter Personal InformationSocial Security Number(Required)Martial Status(Required) Single or Married filing separately Married filing jointly or Qualifying surviving spouse Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.) Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.Step 2: Multiple Jobs or Spouse Works Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs. Do only one of the following. (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4). If you or your spouse have self-employment income, use this option; or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; orMultiple Jobs or Spouse Works (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate Step 3: Claim Dependent and Other CreditsIf your total income will be $200,000 or less ($400,000 or less if married filing jointly):Multiply the number of qualifying children under age 17 by $2,000Multiply the number of other dependents by $500Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total hereStep 4 (optional): Other Adjustments(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here(c) Extra withholding. Enter any additional tax you want withheld each pay period.(Required)(IF YOU WANT TO BE EXEMPT FROM FEDERAL TAXES, PLEASE WRITE OUT "EXEMPT")Step 5: SignHereEmployee’s Signature(Required)Date(Required) MM slash DD slash YYYY Payroll - Bank Account InformationBank Account Type(Required)CheckingSavingsBank Routing Number(Required)Confirm Bank Routing Number(Required)Bank Account Number(Required)Confirm Bank Account Number(Required) Do you have a Commercial Driver's License?(Required) Yes No Type of CDLPlease list out any endorsements Add RemoveWhat is your sleeve size?(Required)RegularLargeX-LargeWhat is your glove size?(Required)88.599.51010.51111.51212.51313.514Do you have a LOTO certificate?(Required) Yes No What is your specific utility?Emergency Contact Name(Required) First Last Emergency Contact Email Emergency Contact Phone(Required)Emergency Contact Address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Δ