Butler One Stop
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New Employee
Employee
Tax
I-9
Payroll
Agreements
1. Employee information
Legal first name
Middle initial
Legal last name
Preferred name
Social Security Number
Date of birth
Phone
Email
Home street address
City
State
ZIP
2. Job information
Start date
Job title
Choose
Cashier
Shift Lead
Cook / Food Prep
Manager
Other
Store location
Pay rate
Employment type
Part-time
Full-time
Temporary
3. Federal W-4 information
Federal filing status
Choose
Single or Married filing separately
Married filing jointly or Qualifying surviving spouse
Head of household
Multiple jobs / spouse works
No
Yes
Dependents amount
Other income
Deductions
Extra withholding per paycheck
4. Missouri W-4 information
Missouri filing status
Choose
Single
Married filing combined
Married filing separate
Head of household
Missouri allowances
MO additional withholding
MO exempt?
No
Yes
5. I-9 information
Citizenship / work authorization status
Choose
U.S. citizen
Noncitizen national of the United States
Lawful permanent resident
Alien authorized to work
Alien / USCIS number if applicable
Document type shown
Choose
U.S. Passport / Passport Card
Permanent Resident Card
Driver License + Social Security Card
Driver License + Birth Certificate
Employment Authorization Document
Other acceptable I-9 document
Document number
Document expiration date
6. Direct deposit
Bank name
Routing number
Account number
Account type
Choose
Checking
Savings
Deposit split / instructions
7. Emergency contact
Contact name
Phone
Relationship
Address / notes
8. Store acknowledgments and agreements
I received and understand the Butler One Stop handbook/store policies, including attendance, no-call/no-show, phone use, customer service, and shift duties.
I understand attendance expectations, punctuality, call-off notice, no-call/no-show rules, and that schedule changes must be approved by management.
I understand cash drawer, safe drop, payouts, refunds, shortages/overages, lottery handling, and accurate closing responsibilities.
I agree to follow all alcohol, tobacco, vape, and lottery ID-check and age-verification rules every time.
I understand lottery ticket activation, validation, scratcher count, opening/ending ticket numbers, and reporting unclear/missing tickets.
I agree to follow food safety, hot food holding, cleaning, waste-log, and freshness rules for all prepared food.
I understand phone-use limits, customer service standards, dress code, respectful conduct, and shift duty expectations.
I will not share POS passwords, safe/alarm codes, camera access, payroll/store records, or confidential business information.
I acknowledge the workplace uses camera/security monitoring for safety, operations, and loss-prevention purposes.
I authorize direct deposit using the payroll information I provided and understand changes must be submitted before payroll cutoff.
I certify the information entered is true and I am signing electronically.
Electronic signature — type full legal name
Signature date
Submit