Fire-Seal LLC — New Hire Enrollment

Step 1 of 8

Personal Information

Populates: Employee Info Sheet, W-4, I-9, IT4, Background Check, 401(k)

1 of 8

Full Name

First Name

M.I.

Last Name

Other Last Names Used (maiden name, aliases — for I-9 and Background Check)

Home Address

Street Address

Apt / Unit

City

State

ZIP Code

Contact and Identity

Primary Phone

Other Phone

Email Address

Social Security Number

- -

Transmitted securely — required for I-9, W-4, IT4, Direct Deposit, and 401(k)

Date of Birth

First Day of Employment

Marital Status

Status

Single Married Divorced Widowed

Spouse Information

Spouse Full Name

Spouse Employer

Spouse Work Phone

1 of 8

Step 2 of 8

Emergency Contact

Populates: Employee Information Sheet

2 of 8

Contact Name

First Name

M.I.

Last Name

Contact Address and Phone

Street Address

City

State

ZIP

Primary Phone

Other Phone

Relationship to Employee

2 of 8

Step 3 of 8

Work Authorization (Form I-9)

Populates: USCIS Form I-9 Section 1

3 of 8

Note: Complete Section 1 no later than your first day. Bring original documents on your start date — no photocopies accepted.

Citizenship / Immigration Status

Select your status

1. U.S. Citizen 2. Noncitizen National of the U.S. 3. Lawful Permanent Resident 4. Alien Authorized to Work

Lawful Permanent Resident

USCIS A-Number

Alien Authorized to Work — Enter expiry and ONE of the following

Work Authorization Expiry

USCIS A-Number

Form I-94 Admission #

Foreign Passport #

Country of Issuance (if using passport)

Acceptable Documents — Bring Originals on Day 1

Official USCIS Form I-9 Edition 01/20/25 — Lists of Acceptable Documents

Upload Identity Documents (Optional)

You may upload your documents now or bring originals on your first day.
If uploading, please provide clear photos or scans of your List A document, or both your List B and List C documents. Accepted formats: JPG, PNG, PDF. Max 10MB per file.

Document 1

Click to browse or drag & drop

JPG, PNG, PDF — max 10MB

Document 2

Click to browse or drag & drop

JPG, PNG, PDF — max 10MB

Not uploading? That's fine — simply bring your original documents to HR on your first day and they will be verified at that time.

3 of 8

Step 4 of 8

Federal Tax Withholding

Populates: IRS Form W-4 (2026) — Fire-Seal LLC EIN 46-2702574

4 of 8

Complete Steps 2-4 only if they apply. Most single-job employees only need Step 1 (Filing Status). Use irs.gov/W4App for precise withholding.

Step 1 — Filing Status

Select one

Single or Married Filing Separately Married Filing Jointly / Qualifying Surviving Spouse Head of Household

Step 2 — Multiple Jobs

Complete only if you or your spouse hold more than one job.

Check if there are only two jobs total (you and spouse)

Step 3 — Dependent Credits

Complete only if income is $200,000 or less ($400,000 if MFJ).

3(a) Children under 17 x $2,200

3(b) Other dependents x $500

3 — Total (3a + 3b + other credits)

Step 4 — Other Adjustments (Optional)

4(a) Other income (not from jobs)Interest, dividends, retirement

4(b) Deductions (if itemizing)

4(c) Extra withholding per pay period

I claim exemption from withholding for 2026 (no tax liability last year, expect none this year)

4 of 8

Step 5 of 8

Ohio State Tax Withholding

Populates: Ohio IT 4 — Employee's Withholding Exemption Certificate

5 of 8

School District

School District of ResidenceLook up at tax.ohio.gov using The Finder tool

School District Number (4 digits)

Section II — Withholding Exemptions

1	Are you a dependent on another person's Ohio return?
2	Filing jointly with spouse on Ohio return?
3	Number of federal dependents
4	Total exemptions (1 + 2 + 3 — auto-calculated)
5	Additional Ohio tax to withhold per pay period (optional)

Section III — Withholding Waiver (check if exempt)

Most employees leave this blank. Check only if your income is exempt from Ohio withholding.

Full-year resident of Indiana, Kentucky, Michigan, Pennsylvania, or West Virginia Ohio resident military servicemember stationed outside Ohio on active duty orders Nonresident military servicemember stationed in Ohio due to military orders Nonresident civilian spouse of military servicemember present in Ohio solely due to orders Exempt under R.C. 5747.06(A)(1) through (6)

5 of 8

Step 6 of 8

Direct Deposit

Populates: Surety HR Direct Deposit Agreement — up to 2 accounts

6 of 8

Required: Attach a voided check or deposit slip. Routing numbers are exactly 9 digits.

Bank Account(s)

Account 1 Primary Account

Name of Financial Institution

Routing Number (9 digits)

Account Number

Account Type

Checking Savings

Amount to Deposit

6 of 8

Step 7 of 8

401(k) Enrollment

Populates: Fire-Seal LLC 401(k) Plan 935036-021 Enrollment and Beneficiary Forms

7 of 8

Reason for This Form

I am eligible and enrolling in the Plan I am stopping all contributions I am changing my contribution level I am changing my beneficiary designation I am changing my future investment mix I elect NOT to make contributions at this time I am changing or stopping catch-up contributions

Contribution Elections

Before-Tax Contributions (Traditional 401k)

Dollar amount per period Percentage of eligible pay No before-tax contributions

Amount or %

After-Tax / Roth 401(k) Contributions

Dollar amount per period Percentage of eligible pay No Roth contributions

Amount or %

Primary Beneficiary

If married, your spouse is automatically the primary beneficiary unless a Spousal Consent Form is signed and notarized.

First Name

M.I.

Last Name

Relationship

Date of Birth

Share %

Beneficiary SSN (required for designation)

Contingent Beneficiary (Optional)

First Name

M.I.

Last Name

Relationship

Date of Birth

Share %

7 of 8

Step 8 of 8

Review and Submit

Confirm your information. Submitting generates your pre-filled enrollment packet PDF.

8 of 8

Personal

Full Name

Date of Birth

Address

SSN (last 4 only)

Phone

Email

First Day of Employment

Marital Status

Emergency Contact

Name

Phone / Relationship

Tax and Banking

I-9 Status

W-4 Filing Status

Ohio School District

Primary Bank

Forms That Will Be Generated

Employee Info Sheet

USCIS Form I-9

IRS Form W-4 (2026)

Ohio IT 4

Background Check Auth.

Direct Deposit (SuretyHR)

401(k) Enrollment

401(k) Beneficiary

By submitting this form, I certify under penalty of perjury that all information provided is true, correct, and complete to the best of my knowledge. I authorize Fire-Seal LLC and Surety HR Inc. to use this information to prepare my new hire enrollment documents. I understand that I will be required to physically sign each generated form before it becomes effective. I also authorize Fire-Seal LLC to conduct a background investigation as described in the Background Check Authorization included in this packet.

I confirm all information is accurate and I authorize the above

Type your full legal name as your electronic signature

Today's Date

8 of 8