EFTA00525179.pdf

EMPLOYMENT APPLICATION Position Applying for. O Full-Time O Part-rune O Seasonal SMTWIFSat. Hours Available: and/or its affiliate , is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, religion, sec, national origin, age, veteran sta tus, disability, or arty other legally pautedcrl status. NAME Soda! Security Number I Are you at least 18 yeas of age O Yes O No First Middle Last Present Street Address Gty State Zip Gty State • Previous Street Address Zip Phone Number Alternative Phone Number Are you a US. Citizen or can you provide verification of your legal right to work in the United States O Yes O No Position Desired CI Full Time Date Available for work Have you ever been employed by ? o Part Tune O Yes C. No Position: - Dales: • Lin names of friends or relatives now employed b.) aid/or Ss affiliate List office machines you an opera ie andude WPM and Shorthand) List other equipment you can operate Do you have any special skills or training related to the position scraght? EDUCATION Name of Institution Gty dr State Grcle Last Year Corn pitted High School 9 10 II 12 College 1 2 3 4 Graduate School . Degree received • O Yes O No Other MILITARY SERVICE BRANCH Rank Attained Dale Entered Date of Disdurge EFTA00525179  EMPLOYMEWI: Include all previous jobs starting with the present or most recent. . May we contact your pr ent employer? 0 Yes O /go .. Employer Pesition Held & Duties Adam, Phone No. Supervisor Dales Employed Pay Rale FP= To: Snarling: Wimp Sensor. for Leasing z Employer Position Held &Dutim Address Phone No. - Supervisor Daus Employed Pay Rate • From: To: Stating: Ending: Reason for Leasing 3. Employer Position Held &Duties . Address Phone No. Supervisor _ Dates Employed Pay Rate From: • To: Staniar EnclInF Roson for Laving Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violations)? O Yes 0 No If yes, Please =plain: PLEASE READ TIDS STATEMENT CAREFULLY I agree to comply withal) rules of this Company. I understand that any falsification or omission of information provided on this application or while inteniewing win be grounds for dim-Lissa/ from employment, even if not discovered until after my separation from the Company. / authorize a thorough investigation to be made in conjunction with this application concerning my character, general septa lion, personal characteristic and mode of living. whichever maybe applicable. I understand this investigation may include personal interviews with third parties, such as family members, business assodates,financial sources,friends,neighbors or others with whom I am acquainted. I/lam hind, I agree that my employment and compensation can be terminated with or without cause and with or without notice at any time, at the option of theCompany or myself. lurrierstandthatnoother representativeof theCompanyother than thePresident of N.A. Property, Inc. has the authority to modify this ageement in any way, and that any such modification must be in a writing signed by both the ?cadent and myself. I have read and affirm the above statement as my own. Sign>ruse One :re. 1 /t I EFTA00525180  LIS. Department or Justice CiMS No III$.066 Immigration mid Naturalization Service Employment Eligibility Verification Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because of a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Verification. Tube completed one signed by employee at the tame employment begins. Print Name Lest First Middle Intlel Maiden Name Addros (Street Name and Number) Apt a Date or Binh (inondildny/year) City State Zip Code Social Secunty • I am aware that federal law provides for I attest. under pentxty of perjury, that I am (check one of the following)* imprisonment and/or fines for false statements or 0 A citizen o national of the United States use of false documents in connection with the 0 A Lawful Permanent Resident (Allen X A An amen authorized to work until / / completion of this form. (Alien i or Admission V) Employees Signature Date (monrh/dayryeat) Preparer andlor Translator Certification. (ro be compieted and sinned a Section 1 is prepared by a person other than the employee.) I attest, under penalty of perjury. that I have assisted in the comp). on of rats form and that to me best of my knowledge the informerion is true and correct. Prepare: 5/Translator s Signature Address (Sven mane and Number. City, State, Zip Code) i Print Name Date (monfh/day/yeat) Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from list A OR examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and capitol/on date, a any. of the document(s) List A OR List B AND List C Document lilt Issuing authority. Document 0 t.§ Expiration Date (if any) —1- 1 t., ; —1_1_ —1_1 Document a. Y.:.: .r., 'P Expiration Date (if any) ....! 1._.1 ES CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the above-fisted document(s) appear to be genuine and to relate to the employee named, that the employee began employment on (month/day/year) and that to the best of my knowledge the employee is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.) Signature of Employer or Authouted Representative Print Name Tide Business or Organization Name Address atreer Name and Number. City. Stale, Zip COON Oato (month/day/year) Section 3. Updating and Reverification. To be completed and signed by employer A New Name Of OpPecalge) 8. Date of rehire Imontfirday/yeadfif affilCibki C. If employee's previous gam of work authorization has expred. provide ihv information below foe the document that establishes swim eligibility. employment Document Trite _ Document sr E .pvatlon Date Of any): / / I attest, under penalty of pertuey, that to the best of my knowledge, Mrs employee in eligible to work in the United and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or AuthonZed Representative Date (nontlildayiyear) Form1.91Rn I Page' EFTA00525181  LISTS OF ACCEPTABLE DOCUMENTS LIST A LIST B LIST C Documents that Establish Both Documents that Establish Documents that Establish Identity and Employment Identity Employment Eligibility Eligibility OR AND 1. Driver's license or ID card U.S. social security card issued 1. U.S. Passport (unexpired or issued by a state or outlying by the Social Security expired) possession of the United States Administration (oilier than a card provided it contains a stating it is not valid for photograph or information such as employment) 2. Certificate of U.S. Citizenship name, date of birth, gender, (INS Form N-560 Of N-5611 height, eye color and address 2. Certification of Binh Abroad 3. Certificate of Naturalization 2. ID card issued by federal, state issued by the Department of (INS form N-550 or N-5701 or local government agencies or State (Form FS-545 or Form entities, provided it contains a 05.13501 photograph or information such as 4. Unexpired foreign passport. name, date of birth, gender, with 1-551 stamp or attached height, eye color and address INS Form 1-94 indicating 3. Original or certified copy of a unexpired employment 3. School ID card with a birth certificate issued by a state, authorization photograph county, municipal authority or outlying possession of the United 5. Permanent Resident Card or 4. Voter's registration card States bearing an official seal Alien Registration Receipt Card with photograph (INS Form 5. U.S. Military card or draft record I-151 or I-551) 6. Military dependent's ID card 4. Native American tribal document 6. Unexpired Temporary Resident Card (INS Form I-6881 7. U.S. Coast Guard Merchant Mariner Card 5. U.S. Citizen ID Card (INS Form 7. Unexpired Employment 8. Native American tribal document 1-1971 Authorization Card (INS Form 1-688A1 9. Driver's license issued by a Canadian government authority 6. ID Card for use of Resident 8. Unexpired Reentry Permit (INS Citizen in the United Stales Form 1-3271 For persons under age 18 who (INS Form 1-179) are unable to present a document listed above: 9. Unexpired Refugee Travel Document (INS Form 1-5711 7. Unexpired employment 10. School record nr report card authorization document issued by 10. Unexpired Employment the INS (other than those listed Authorization Document :ssued by 11. Clinic, doctor or hospital record under List Al the INS which contains a photograph (INS Form I -6673B1 12. Day-care or nursery school record Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-2741 Ft= I 9:51.t: ittreterr enc. 3 EFTA00525182  NOTIFICATION/RELEASE OF INFORMATION FORM be conducted on you in the The purpose of this form is to notify you that consumer report will course of consideration for employment with: Last Name: First Name: Middle Name: Social Security #: State of Issue: Current Address: City: State: Zip: In connection with this request I authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to information about my employment, education, consumer credit history, driving record, criminal record and general public history to the person or company with which this form has been filed, or their agent. This releases the aforesaid parties from any liability and responsibility for collection of the above information. APPLICANT'S SIGNATURE: DATE: EFTA00525183  CONFIDENTIALITY AGREEMENT In order to induce NES, LLC ("NES") to consider the undersigned for employment or engagement as an independent contractor to provide services, including, without limitation, services with respect to NES, Jeffrey Epstein ("Epstein") and any of the Epstein Companies (as hereinafter defined) and real property directly and indirectly owned or occupied by NES, Epstein or any of the Epstein Companies (the "Properties"), and in consideration of any employment or engagement that the undersigned may obtain with NES, Epstein or any of the Epstein Companies, whether with respect to the Properties or otherwise, and any compensation or other remuneration to be hereafter paid to the undersigned in connection therewith, the undersigned, (hereinafter sometimes referred to as the Applicant"), acknowledges that the Applicant has been informed of the Applicant's obligations hereunder and that such obligations are a condition to the consideration by NES, Epstein or any of the Epstein Companies of the Applicant's employment or engagement, and to any employment or engagement that the Applicant may obtain, and the Applicant hereby agrees as follows: Section 1. Term of Employment; Termination. In the event that the Applicant is hereafter employed or engaged as an independent contractor by NES, Epstein or any of the Epstein Companies, the Applicant agrees and understands that nothing in this Agreement shall confer any right on the Applicant with respect to the grant or continuation of the Applicant's employment or engagement as an independent contractor. The Applicant further agrees and understands that, in the event that the Applicant is employed or engaged as an independent contractor, any breach of this Agreement by the Applicant will result, in addition to any and all other remedies which may then be available to NES, Epstein or any of the Epstein Companies, as the case may be, in the Applicant's immediate termination. Section 2. Confidentiality Obligations of the Applicant. 2.1 Defmition of Confidential Information. (a) For purposes of this Agreement, the term "Confidential Information" shall mean any "Business Information" (as hereinafter defined) and any "Personal Information" (as hereinafter defined) about any of: (i) the Properties or any other real property owned or occupied directly or indirectly by any of NES, Epstein or any of the Epstein Companies; (ii) NES, (iii) Epstein; (iv) any and all corporations, limited liability companies, trusts, limited partnerships, general partnerships or other entities with which Epstein is affiliated ("Epstein Companies"); (v) any of the members, managers, directors, officers, shareholders, limited partners, general partners, trustees, beneficiaries, employees, contractors or agents of NES, Epstein or any of the Epstein Companies; (vi) any person residing at, visiting or staying for any duration at any of the Properties; and (vii) any personal associate, business associate or client of any of the persons described in the above clauses (ii) through (vi), inclusive; previously or hereafter gathered or learned by the Applicant directly or indirectly during the course of the any interactions between the Applicant, on the one hand, and any of NES, Epstein and/or any of the Epstein Companies, or any representatives of NES, Epstein or any of the Epstein Companies, on the other hand, including, without limitation, during the course of Applicant's application for employment or engagement by NES, Epstein or any of the Epstein Companies and/or in connection with any employment or engagement of the Applicant by NES, Epstein or any of the Epstein Companies. EFTA00525184  (b) For purposes of this Agreement, the term "Business Information" shall mean information of any type which is commonly considered of a confidential nature and includes, but is not limited to, any information (whether in oral, written, photographic, electronic or other recorded form) regarding the existence, identities, contact information, and business records of; the business plans of; mechanized or nonmechanized systems of accounting of; IT related systems or information of; methods of doing business of; vendor information (including, without limitation, existence, identities, contact information, records, fees, and disbursements of, and services and materials provided by, any and all vendors, contractors, consultants, and professional advisors) of; confidential business lists and other proprietary data of; assets of; investment strategies, transactions, records, procedures and history of; financial records of; the skills, business activities, compensation and financial net worth of; and any other information of a similar nature about; any of the persons or entities set forth in Section 2.1(a) (the "Classified Parties"). (c) For purposes of this Agreement, the term "Personal Information" shall mean information of any type which is commonly considered of a personal nature and includes, but is not limited to, information (whether in oral, written, photographic, electronic or other recorded form) regarding the identities of; contact information of; personal characteristics of; physical descriptions of; non-business activities of; IT systems and information of; personal assets of; personal records of; personal plans of; personal lifestyles of; relationships of; friends of; relatives of; individuals who associate with or who are invited to associate with; and any other information of a similar nature about; any of the Classified Parties; and shall also include, without limitation, the appearance and exterior and interior layout of, any and all improvements on, and furniture, furnishings, and other items of personal property contained anywhere in or on, any of the Properties or any other real property directly or indirectly owned or occupied by NES, Epstein or any of the Epstein Companies. 2.2 Confidential Information Shall Not Be Discussed. At all times hereafter, the Applicant will hold in the strictest confidence and will not, directly or indirectly, use, communicate, publicize, lecture upon, publish or in any manner disclose any Confidential Information, unless NES has expressly authorized in writing such use, communication, publicizing, lecturing, publication, or disclosure. The Applicant hereby assigns to NES any and all rights the Applicant may have or acquire in any Confidential Information and acknowledges that all Confidential Information shall be the sole and exclusive property of NES. The Applicant further agrees and acknowledges that under this Agreement, the Applicant is obligated to use the Applicant's best efforts to ensure that no Confidential Information is used, communicated, publicized, lectured upon, published or disclosed by any persons employed or engaged by the Applicant or under the Applicant's supervision or control. To the extent that the Applicant has any doubts, either now or in the future, as to whether information the Applicant possesses is Confidential Information as defined herein, the Applicant will contact NES, for written clarification and approval before divulging or using such information in any manner whatsoever. Third Party Information Shall Not Be Disclosed. The Applicant understands that the Applicant may receive Confidential Information from third parties, as well as from NES. The Applicant acknowledges and agrees that Confidential Information which the Applicant receives from third parties is to be treated in the same manner as Confidential Information received from NES and that all of the Applicant's obligations hereunder apply to all Confidential EFTA00525185  Information received, regardless of its source. 2.4 Return of Documents. Upon demand by NES, and upon the expiration or termination of any employment or engagement as an independent contractor of the Applicant by NES, regardless of the reason or basis, if any, for such expiration or termination, the Applicant will deliver to NES any and all documents, written materials, notes, drawings, photographs, specifications and any other materials of any type or nature whatsoever (whether in written, photographic, electronic or other recorded form) which the Applicant has in the Applicant's possession or control, and all drafts, copies and electronic file copies of all or any part thereof, which may constitute, include, reflect or disclose any Confidential Information. Section 3. Review of Agreement. The Applicant acknowledges that the Applicant has read this Agreement, and that the Applicant has had the opportunity to review it and consult about it with the Applicant's own counsel if the Applicant so desires, before signing it. Section 4. Conflicts. 4.1 Avoidance of Conflict of Interest. If the Applicant is or subsequently becomes employed by NES, Epstein or any of the Epstein Companies (rather than being engaged as an independent contractor), the Applicant agrees that during the term of any such employment, so long as the Applicant is employed on a full-time basis, the Applicant will not, without the express written consent of NES, engage in any employment with any third party, or engage in any other business activity that would in any way conflict with the performance of the Applicant's duties of employment. 4.2 No Conflicting Obligations. The Applicant warrants and represents that the Applicant has not heretofore violated any provisions of this Agreement and that the Applicant has not entered into, or made, and agrees that the Applicant will not enter into or make, any written or oral agreement, undertaking, promise, or representation that conflicts with or violates the provisions of this Agreement or otherwise impairs the Applicant's ability to strictly perform the Applicant's obligations under this Agreement or to fully comply with the provisions of this Agreement. The Applicant further warrants and represents that the Applicant is not subject to any subpoena, injunction, decree, writ or order of any court or other authority or to any other duty or responsibility, legal or otherwise, which conflicts with the provisions of this Agreement or otherwise impairs the Applicant's ability to strictly perform the Applicant's obligations under this Agreement or to fully comply with the provisions of this Agreement. The Applicant shall immediately inform NES should the Applicant subsequently become subject to any such subpoena, injunction, decree, writ, order, duty or responsibility. Section 5. Remedies. 5.1 Equitable Relief. The Applicant acknowledges that the Confidential Information constitutes unique and confidential information of NES and the Classified Parties and in the event of a breach or a threatened breach of this Agreement, NES and any affected Classified Parties, will be irreparably harmed and there will be no adequate remedy at law. Therefore, in 3 EFTA00525186 addition to any and all other rights and remedies NES and any such Classified Parties may have, NES and such Classified Parties shall be entitled to injunctive or other equitable relief in the event of a breach or threatened breach hereof and the Applicant hereby waives any right to assert as a defense that there is an adequate remedy at law. 5.2 Liquidated Damages. In addition to any and all other rights, remedies or damages available at law or in equity, the Applicant agrees that if any court of competent jurisdiction finds that the Applicant has breached any of the provisions of this Agreement, the Applicant will pay NES or any affected Classified Party the sum of One Hundred Thousand ($100,000.00) Dollars, as liquidated damages and not as a penalty. The Applicant recognizes and understands that it would be difficult or impossible to calculate the actual amount of damages resulting from such a breach, and acknowledges that the sum of One Hundred Thousand ($100,000.00) Dollars would be reasonable under the circumstances. Section 6. General Provisions. 6.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of New York applicable to contracts executed, delivered and to be fully performed in such jurisdiction, without giving effect to the principles of conflicts of law. 6.2 Severability. If one or more of the provisions of this Agreement are deemed invalid or unenforceable by law, then the remaining provisions hereof will continue in full force and effect, without regard to the invalid or unenforceable provision or provisions hereof, as the provisions of this agreement are intended to be and shall be deemed severable. 6.3 Survival. The provisions of this Agreement shall continue in full force and effect, regardless of whether the Applicant is ultimately employed or engaged by NES, Epstein or any of the Epstein Companies, and if the Applicant is so employed or engaged, the provisions hereof shall survive the expiration or termination of any such employment or engagement of the Applicant, regardless of the reason or basis, if any, for such expiration or termination. 6.4 Binding Effect. This Agreement and all of the provisions hereof shall inure to the benefit of, and be enforceable by, NES, and its successors and assigns, and shall be binding upon the Applicant and the Applicant's heirs, personal representatives, successors and assigns. This Agreement is intended for the benefit of and to be enforceable by NES and by the Classified Parties as third-party beneficiaries of this Agreement. 6.5 Waiver. No waiver of any provision of this Agreement shall be valid unless expressly given in writing, signed by the party against whom such waiver is sought to be enforced, and specifying the specific instance and the specific purpose for which such waiver is given. Each such waiver, if any, shall be effective only for the specific instance and for the specific purpose for which it is given. No waiver by NES or any Classified Party of any breach of this Agreement shall be a waiver of any preceding or succeeding breach. No waiver by NES or any Classified Party of any right under this Agreement shall be construed as a waiver of any other right. Neither NES nor any Classified Party shall be required to give notice to enforce strict adherence to all of the terms and 4 EFTA00525187 provisions of this Agreement. 6.6 Headings. The headings contained herein are for convenience only and shall not control or effect in any way the meaning or interpretation of the provisions hereof. 6.7 Entire Agreement. This Agreement sets forth the entire agreement and understanding between NES and the Applicant relating to the subject matter hereof and supersedes and merges all prior discussions between them relating to the subject matter hereof. No modification of, or amendment to, this Agreement will be effective unless in writing signed by the party to be charged therewith. If the Applicant is hereafter employed or engaged by NES, Epstein or any of the Epstein Companies, any subsequent change or changes in the Applicant's duties, salary or other remuneration will not affect the validity or scope of this Agreement. Signed: Print Name: Date: Address: 5 EFTA00525188  using this calculator if you have a more Specific Instructions Form W-4 (2019) complicated tax situation, such as if you have a working spouse, more than one job, Personal Allowances Worksheet Future developments. For the latest information about any future dovolopmonts or a large amount of nonage income not Complete this worksheet on page 3 first to related to Form W-4, such as legislation subject to withholding outside of your job. determine the number of withholding enacted after it was published, go to After your Form W-4 takes effect, you can allowances to claim. v./ww.im.90v/FonnW4. also use this calculator to see how the amount of tax you're having withheld Line C. Head of householdplease note: Purpose. Complete Form W-4 so that your compares to your projected total tax for Generally, you may claim head of household employer can withhold the correct federal 2019. If you use the calculator, you don't filing status on your tax return only if you're income tax from your pay. Consider need to complete any of the worksheets for unmarried and pay more than 50% of the completing a new Form W-4 each year and Font W-4. costs of keeping up a home for yourself and when your personal or financial situation a qualifying individual. See Pub. 501 for changes. Note that if you have too much tax more information about filing status. withheld, you will receive a refund when you Exemption from withholding. You may file your tax return. If you have too little tax Line E. Child tax credit. When you file your claim exemption from withholding for 2019 withheld, you will owe tax when you fie your tax retum, you may be eligible to claim a if both of the blowing apply. tax retum, and you might owe a penalty. child tax credit for each of your eligible • For 2018 you had a right to a refund of all children. To qualify, the child must be under Filers with multiple jobs or working age 17 as of December 31, must be your federal income tax withheld because you spouses. If you have more than one job at had no tax liability, and dependent who lives with you for more than a time, or if you're married filing jointly and half the year, and must have a valid social • For 2019 you expect a refund of an your spouse is also working, read all of the security number. To learn more about this federal income tax withheld because you instructions including the instructions for credit, see Pub. 972, Child Tax credit. To expect to have no tax liability. the Two-EamersrMultiple Jobs Worksheet reduce the tax withheld from your pay by If you're exempt, complete only lines 1, 2. before beginning. taking this credit into account, follow the 3, 4, and 7 and sign the form to validate it. Nonwage Income. If you have a large instructions on line E of the worksheet. On Your exemption for 2019 expires February amount of nonwage income not subject to the worksheet you will be asked about your 17, 2()20. See Pub. 505, Tax Withholding withholding, such as interest or dividends, total income. For this purpose, total income and Estimated Tax, to learn more about consider making estimated tax payments includes all of your wages and other whether you qualify for exemption from using Form 1040-ES. Estimated Tax for Income, including income earned by a withholding. Individuals. Otherwise, you might owe spouse if you are filing a joint return. additional tax. Or, you can use the Line F. Credit for other dependents. General Instructions Deductions. Adjustments, and Additional When you file your tax return, you may be Income Worksheet on page 3 or the eligible to claim a credit for other If you aren't exempt, follow the rest of calculator at wivacirs.gov/W4App to make these instructions to determine the number dependents for whom a chid tax credit sure you have enough tax withheld from can't be claimed, such as a qualifying child of withholding allowances you should claim your paycheck. If you have pension or for withholding for 2019 and any additional who doesn't meet the age or social annuity income, see Pub. 505 or use the security number requirement for the child amount of tax to have withheld. For regular calculator at www.irs.gov/W4App to find wages, withholding must be based on tax credit, or a qualifying relative. To learn out if you should adjust your withholding more about this credit, see Pub. 972. To allowances you claimed and may not be a on Form W-4 or W-4P. flat amount or percentage of wages. reduce the tax withheld from your pay by Nonresident alien. If you're a nonresident taking this credit into account, follow the You can also use the calculator at alien, see Notice 1392, Supplemental Form instructions on line F of the worksheet. On invvtictoos/W4App to determine your W-4 Instructions for Nonresident Aliens, the worksheet, you will be asked about tax withholding more accurately. Consider before completing this form. your total income. For this purpose, total. Separate here and give Form W-4 to your employer. Keep the worksheet(s) for your records. Employee's Withholding Allowance Certificate Fa.,W-4 I OMB No. 1545.0074 Owner elate Teary Nernst Revenueffenic• iii Whether you're entitled to claim a certain number of allowances or exemption from withholding Is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 2019 I Your first narne and mddie initial Last name 2 Your social security number Home address (number and street or rural route) 3 DSinges [Warned ElMarried, but withhold at higher Single rate. Now downed fang separately. check "married, but withhold at higher SAO. rats' City or town, stale. and ZIP code 4 If your lost name differs from that shown on your social security cord. check here. You must call 800.7724213 for a replacement card. Ile• D 5 Total number of allowances you're claiming (from the applicable worksheet on the following pages) . . . . 5 6 Additional amount, if any, you want withheld from each paycheck 6 $ 7 I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a refund of all federal income tax withheld because I expect to have no tax liabiity If you meet both conditions, write "Exempt" here P 171 Under penalties of perjury, I declare that I have examined this certificate and. to the best of my knowledge and baler, it is true, correct. and complete. Employee's signature (This form is not valid unless yOu sign it) r• Date ev a Employer's tume and address IF-mak/yen Cannata boxes 8 and to J sending to IRS arid candour 9 Fest date of 10 EMPIDYer demitation bones B. 9. and 10 a mincing to State Directory of New Sent Salpigment number For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cm. No. 102200 Form W-4 poi% EFTA00525189 Form W-4 (2019) Pogo 2 income includes all of your wages and don't complete this worksheet, you might and 10 to comply with the new hire other income, including income earned by have too little tax withheld. If so, you will reporting requirement for a newly hired a spouse if you are filing a joint return. awe tax when you file your tax return and employee. A newly hired employee is an Line G. Other credits. You may be able to might be subject to a penalty. employee who hasn't previously been reduce the tax withheld from your Figure the total number of allowances employed by the employer, or who was paycheck if you expect to claim other tax you're entitled to claim and any additional previously employed by the employer but credits, such as tax credits for education amount of tax to withhold on all jobs using has been separated from such prior (see Pub. 970). If you do so, your paycheck worksheets from only one Form W-4. Claim employment for at least 60 consecutive will be larger, but the amount of any refund as allowances on the W-4 that you or your days. Employers should contact the that you receive when you file your tax spouse file for the highest paying job in appropriate State Directory of New Hires to return will be smaller. Follow the your family and claim zero allowances on find out how to submit a copy of the instructions for Worksheet 1-6 in Pub. 505 Forms W-4 filed for all other jobs. For completed Form W-4. For information and if you want to reduce your withholding to example, if you earn 560,000 per year and links to each designated State Directory of take these credits into account. Enter "-0-" your spouse earns $20,000, you should New Hires (including for U.S. territories), go on lines E and F if you use Worksheet