Employment Application

First Name Last Name Email Phone Number Street Address (Number and Name) City or Town State ZIP Code Date of Birth Required to complete Section 1 of Form I-9. Future dates are not accepted. Social Security Number (9 digits) Photo of Social Security Number (SSN) This can be a photo of your SSN card or any official document that shows your full Social Security Number. Second Form of ID (Passport, Driver’s License, etc.) This can be a Passport, Driver’s License, Permanent Resident Card, or any other official U.S. government-issued ID. How do you file your taxes

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.)

Caution: To claim certain credits or deductions on your tax return, you (and/or your spouse if married filing jointly) are required to have a social security number valid for employment. See page 2 for more information.

Form W-4 (2026): Federal tax withholding

TIP: Consider using the estimator at www.irs.gov/W4App to determine the most accurate withholding for the rest of the year if you are completing this form after the beginning of the year; expect to work only part of the year; or have changes during the year in your marital status, number of jobs for you (and/or your spouse if married filing jointly), dependents, other income (not from jobs), deductions, or credits. Have your most recent pay stub(s) from this year available when using the estimator. At the beginning of next year, use the estimator again to recheck your withholding.

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. Review the official Form W-4 instructions and worksheets before signing.

Nonresident alien status: I am a nonresident alien for federal tax withholding purposes. I have reviewed IRS Notice 1392 before completing this form. Nonresident aliens generally should not claim Step 3 credits; certain residents of Canada, Mexico, or South Korea and eligible students or business apprentices from India may qualify.

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 the 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 of the official Form W-4 and enter the result in Step 4(c) below; or

(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 Step 2(b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, Step 2(b) is more accurate.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

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):

(a) Multiply the number of qualifying children under age 17 by $2,200 (b) Multiply the number of other dependents by $500 Other credits

Add the amounts from Steps 3(a) and 3(b), plus the amount for other credits. Enter the total here.

Step 4: 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. Use the Deductions Worksheet on page 4 to determine the amount of deductions you may claim, which will reduce your withholding. (If you skip this line, your withholding will be based on the standard deduction.) Enter the result here.

(c) Extra withholding. Enter any additional tax you want withheld each pay period.

Exempt from withholding. I claim exemption from withholding for 2026, and I certify that I meet both of the conditions for exemption for 2026. See Exemption from withholding on page 2. I understand I will need to submit a new Form W-4 for 2027.

Citizenship or Immigration Status

1. A citizen of the United States 2. A noncitizen national of the United States 3. A lawful permanent resident

Select Location Are you hired for?

Cashier Kitchen

First Day of Work Do you want Direct Deposit?

Yes No

Signature

Employment Application

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim dependent and other credits

Step 4: Other Adjustments

¡Gracias! / Thanks! 🎉