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INDIVIDUAL PAYROLL RECORD
Name ________________________________________________________________________________________________
Employee # __________________________
Address: _______________________________________________________________________________________________________________________________________________________________________
Social Security # _________-______-_______ Position _________________________ Birth Date ____________________ Phone # _______________________________
Regular Rate ______ Overtime Rate ______ Withholding Status ______________ First Day Worked _____________ Last Day Worked _____________
PERIOD TOTAL HOURS WAGES TOTAL DEDUCTIONS TOTAL NET Check
ENDING Regular Overtime Regular Overtime Cafeteria GROSS Social Medicare Pretax Federal State DEDUC- PAY Number
Deduct. PAY Security Withhold. Retire. Withhold. Withhold. TIONS
1 JAN.
2
3
4
5
TOTAL JAN.
1 FEB.
2
3
4
5
TOTAL FEB.
1 MAR.
2
3
4
5
TOTAL MAR.
TOTAL
1ST QTR.
1 APR.
2
3
4
5
TOTAL APRIL
1 MAY
2
3
4
5
TOTAL MAY
1 JUNE
2
3
4
5
TOTAL JUNE
TOTAL
2ND QTR.
YEAR
TO DATE