What if my name differs from my SSN record?

Provide documentation showing legal name change (marriage certificate or court order) and update both the statement and the agency records to prevent tax or payroll mismatches.

Can the statement be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and retention requirements are met.

How long should employers keep these records?

Retain payroll and employment records at least three years per IRS guidance and I-9 records per 8 CFR §274a.2; industry rules like HIPAA may require longer retention.

Do electronic submissions require a consumer disclosure?

Consumer-facing electronic records that replace paper may require an ESIGN consumer disclosure explaining rights to a paper copy and how to withdraw consent.

What format should bank information be in?

Enter routing and account numbers as digits only and confirm account type; many employers require a voided check or bank validation for direct deposit setup.

Who can sign on behalf of an employee?

The employee must sign their own statement unless a documented power of attorney or legal guardian is present and authorized under applicable law.

Electronic Signature
Templates
HR
Employee Information Statement

Employee Information Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE INFORMATION STATEMENT

Personal Information

Full Legal Name Preferred Name / Nickname Home Address

Primary Phone

Email Address

Date of Birth

Last 4 of SSN

Emergency Contact

Contact Name

Relationship

Contact Phone

Position Information

Job Title

Department

Reporting Manager

Proposed Start Date

Salary / Rate

Employment Type (select all that apply)

Full-Time Part-Time Contractor Temporary

Work Location

Employment History

Provide your last two employers. If additional space is needed, attach a separate sheet signed and dated.

Employer 1 — Company Name Address / Phone

Title

From

To

Primary Responsibilities Reason for Leaving

Employer 2 — Company Name Address / Phone

Title

From

To

Primary Responsibilities Reason for Leaving

Education

Highest Degree or Credential Institution Graduation Date Additional Training / Certifications

Professional References

Provide three professional references who can attest to your work performance and character.

Reference 1 — Name

Reference 2 — Name

Reference 3 — Name

Legal Disclosures

At-Will Employment: I understand that my employment, if offered and accepted, is on an at-will basis. Either I or the employer may terminate the employment relationship at any time, with or without cause or notice, except where contrary to applicable law or a written agreement signed by an authorized representative of the employer.

Equal Opportunity: The employer maintains an equal opportunity policy and does not discriminate against applicants or employees on the basis of race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable law. Reasonable accommodations will be provided in accordance with applicable law.

Authorization & Background Check Consent

By signing below I authorize the employer and its representatives to contact current and former employers, references, educational institutions, and any other persons or entities to verify the information I have provided. I further authorize the employer to obtain consumer reports, criminal history, motor vehicle records, and other investigative reports as permitted by law. I understand that any offer of employment may be conditioned upon the results of such checks and any required drug or medical examinations.

Consent to background and reference checks: I consent

Consent to contact prior employers and references: I consent

Applicant Certification

I certify that all information provided on this Employee Information Statement is true, accurate and complete to the best of my knowledge. I understand that falsification, omission, or materially misleading statements may result in withdrawal of an offer, discipline, or termination of employment. I agree to notify the employer of any changes to the information contained herein.

I acknowledge that I have read, understand, and agree to the statements above and that this information may be used for employment-related records.

Employee Printed Name:

Signature:

Date:

What an Employee Information Statement Is

An Employee Information Statement is a standardized form used during onboarding and personnel updates to collect contact details, tax and payroll data, emergency contacts, and required attestations from an employee. It centralizes identity, payroll, tax withholding, benefits enrollment pointers, and signature attribution so employers can process payroll, meet compliance obligations, and maintain complete personnel records.

Why a Clear Statement Matters for Employers and Employees

A concise Employee Information Statement reduces administrative errors, supports compliance with payroll and immigration recordkeeping, and creates a single source of truth for personnel data used across HR, payroll, and benefits.

Who Completes and Relies on This Statement

Employers, HR teams, payroll providers, and new hires use the Employee Information Statement to establish or update employment records.

HR administrators and payroll teams for onboarding, tax setup, and benefits enrollment processes.
New employees and rehires providing legal name, SSN/TIN, address, and bank details for pay and tax reporting.
Third-party payroll processors and benefits vendors who need standardized employee data for accurate processing.

Accurate completion streamlines downstream tasks such as W-2 generation, I-9 retention, direct deposit setup, and emergency contact access.

Core Sections to Include in a Professional Statement

A professional Employee Information Statement groups related items so data entry and verification are straightforward. Organize sections for identity, payroll, tax, benefits, emergency contacts, and authorizations.

Identity

Full legal name, preferred name, date of birth, and government ID details for verification and background checks.

Payroll

Direct deposit routing and account numbers, pay frequency, and withholding elections used to process payroll accurately.

Tax Withholding

Filing status and exemptions or links to W-4 and state withholding forms to ensure correct tax calculations.

Benefits

Enrollment choices, plan IDs, and beneficiary designations required to activate health, retirement, or insurance coverage.

Emergency Contact

Primary and secondary contacts with relationship and phone numbers for urgent notifications.

Authorizations

Signature block, electronic consent language, and attestations for background checks or I-9 identity verification.

Step-by-Step: Completing the Employee Information Statement

Follow these sequential steps to complete and verify the statement before submission to HR or payroll.

01

Provide Identity: Enter legal name and ID details exactly.
02

Set Payroll: Add bank info and pay frequency.
03

Select Tax Status: Complete withholding elections and check accuracy.
04

Sign and Submit: Affirm accuracy, sign, and transmit to HR.

Typical Digital Workflow for Submission

A digital Employee Information Statement follows a short workflow from sender to HR with verification and audit steps.

Upload Document: Employer uploads the statement template.
Place Fields: Add required name, SSN, bank, and signature fields.
Authenticate Signer: Use email link, SMS code, or stronger methods.
Capture Audit Trail: Store timestamp, IP, and signer actions.

Digital Form Configuration Checklist

Configure the online form to reduce errors, collect required verifications, and preserve audit data.

Field	Configuration
Required Fields	Mark name, SSN, bank routing, and signature as required.
Authentication	Set email verification or SMS OTP for signer validation.
Conditional Logic	Show state tax fields only when applicable.
Attachments	Allow uploads for ID verification or voided check images.

Technical Options for Sharing and Signing

Choose a platform that supports secure forms, audit trails, and the integrations you need for HR and payroll systems.

File Formats: PDF, DOCX, HTML supported
Integrations: Works with Salesforce, NetSuite, Microsoft 365
Authentication: Email, SMS, KBA, SSO

Ensure the chosen provider supports required compliance standards (ESIGN, UETA) and any industry-specific certifications such as HIPAA when handling protected health information.

Security and Compliance Snapshot

Encryption in Transit: TLS 1.2/1.3

Encryption at Rest: AES-256

HIPAA: Compliant — BAA required

ESIGN / UETA: Compliant

SOC 2 Type II: Certified

ISO 27001: Certified

Key Risks and Potential Penalties for Errors

Incorrect TIN: Backup withholding 24%

Late 1099/W-2: Penalties $60–$330 per form

I-9 Violations: $281–$2,789 per violation

Intentional Disregard: $660+ per form

HIPAA Breach: Civil and criminal penalties

Misfiled Records: Payroll delays and audit exposure

Common Preparation Mistakes to Avoid

Entering nicknames instead of legal names, causing mismatches on tax forms and background checks.
Typographical errors in routing or account numbers that delay direct deposit and trigger manual corrections.
Failing to collect signed consent for electronic records when consumer-facing disclosures are required under ESIGN.
Omitting emergency contact details or outdated phone numbers that hinder urgent communications.

Key Deadlines and Retention Expectations

Be aware of federal filing dates and retention rules that interact with employee records and tax reporting.

W-2 to Employee:

Jan 31 delivery to employees

1099-NEC:

Jan 31 to recipient and IRS

I-9 Retention:

3 years after hire or 1 year after termination

Form 1040:

April 15 individual return deadline

Recordkeeping:

Retain payroll records per federal and state rules

eSignature Platform Pricing and Feature Comparison

Compare entry-level pricing and key features for common eSignature providers. signNow is listed first per vendor ordering rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Yes	Yes	Yes	Yes
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Real-World Examples of Employee Information Workflows

Two organizations illustrate how a standardized statement reduces friction and supports compliance during onboarding and ongoing updates.

Optica Ventures — COO

Optica simplified onboarding with a single online statement for all hires, reducing processing time.

Streamlined form entry and verification.
The interface was easy for staff and external contractors, enabling faster payroll setup and fewer data reconciliation issues during monthly runs.

Fertility Centers of Illinois — Founder

The center centralized employee data and signatures for onboarding and benefits enrollment.

Used secure eSignature across mobile and desktop.
This approach improved compliance with audit trails, decreased paper handling, and allowed staff to update records without in-person visits.

Frequently Asked Questions About Employee Information Statements

Answers to common questions about accuracy, electronic signatures, retention, and required supporting documents for employee records.

Need help? Contact support

What if my name differs from my SSN record?
Provide documentation showing legal name change (marriage certificate or court order) and update both the statement and the agency records to prevent tax or payroll mismatches.
Can the statement be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and retention requirements are met.
How long should employers keep these records?
Retain payroll and employment records at least three years per IRS guidance and I-9 records per 8 CFR §274a.2; industry rules like HIPAA may require longer retention.
Do electronic submissions require a consumer disclosure?
Consumer-facing electronic records that replace paper may require an ESIGN consumer disclosure explaining rights to a paper copy and how to withdraw consent.
What format should bank information be in?
Enter routing and account numbers as digits only and confirm account type; many employers require a voided check or bank validation for direct deposit setup.
Who can sign on behalf of an employee?
The employee must sign their own statement unless a documented power of attorney or legal guardian is present and authorized under applicable law.

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