Frontline Medical EMS

Payroll Setup

Complete all fields accurately. All payroll is fulfilled via Direct Deposit.

General Information

Frontline ID# *

Full Name *

Address *

Phone Number *

Date of Birth *

Agreed Hourly Rate *

Social Security Number *

2024 W-4 Tax Status

	Filing Status	# Dependents	Citizenship	Type of ID
California Taxes
Federal Taxes

Additional CA State Tax Deduction? If YES, how much?

Additional Federal Tax Deduction? If YES, how much?

Banking Information

Name of Bank *

Type of Account *

Routing Number *

Account Number *

Repeat Account Number *

Check Your Entries. This Must Be Accurate.

By typing your name and ID#, I understand that all Frontline Medical Payroll will be fulfilled via Direct Deposit. I also attest that the above information is true and accurate.

Type your FIRST and LAST name, and Frontline ID# *

This form is submitted securely to the Frontline Medical EMS payroll department.