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Veteran and Linemen Owned

Contractor Application Form

Please fill out the following information.

Step 1 of 4

Name

This field is for validation purposes and should be left unchanged.

Full Legal Name(Required)

First Middle Last

Physical Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Gender

Upload Drivers License(Required)

Drop files here or

Max. file size: 8 MB.

Drivers License Number(Required)

W4 - Employee’s Withholding Certificate

Do you qualify and wish to be exempt from federal taxes?(Required)

Yes

Step 1: Enter Personal Information

Social 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; or

Multiple 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 Credits

If 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 $2,000

Multiply the number of other dependents by $500

Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here

Step 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

(IF YOU WANT TO BE EXEMPT FROM FEDERAL TAXES, PLEASE WRITE OUT "EXEMPT")

Step 5: SignHere

Employee’s Signature(Required)

Date(Required)

Do you have a Commercial Driver's License?(Required)

Yes

Type of CDL

Please list out any endorsements

What is your sleeve size?(Required)

What is your glove size?(Required)

Do you have a LOTO certificate?(Required)

Yes

What is your specific utility?

Emergency Contact Name(Required)

First Last

Emergency Contact Email

Emergency Contact Phone(Required)

Emergency Contact Address