Day 1 Intake — Backbone

Employee

Day 1 Intake — Werner Coach Lines, Inc.

Social Security Number

Step 1 of 5 — Encrypted at rest, never stored in plaintext

SSN *

AES-256 encrypted before storage. Tap to reveal while typing.

W-4 — Employee's Withholding Certificate

Step 2 of 5 — Federal tax withholding elections

Full Name

Address

Step 1(c): Filing Status *

Single or Married Filing Separately Married Filing Jointly Head of Household

Step 2: Multiple Jobs or Spouse Works Check if you (or your spouse) hold two or more jobs simultaneously

Step 3: Claim Dependents ($)

Step 4(a): Other Income ($)

Step 4(b): Deductions ($)

Step 4(c): Extra Withholding ($/paycheck)

Exemption Claim exemption from withholding (W-4 line 7) — I had no federal income tax liability last year and expect none this year

Employee Signature (typed) *

Date *

Your electronic signature is legally binding and equivalent to a handwritten signature.

I-9 Section 1 — Employee Information and Attestation

Step 3 of 5 — To be completed by the employee on or before the first day of employment

Last Name

First Name

Middle Initial

Other Last Names Used (if any)

Date of Birth

Address

Citizenship / Immigration Status *

A citizen of the United States A noncitizen national of the United States A lawful permanent resident (Alien Reg. Number / USCIS Number) An alien authorized to work until (expiration date)

USCIS Number / Alien Registration Number *

Work Authorization Expiration Date *

Provide ONE of the following:

USCIS / A-Number

I-94 Admission Number

Foreign Passport Number

Country of Issuance (if passport)

Employee Signature (typed) *

Date *

I attest, under penalty of perjury, that I am (check one of the above), that the information provided is true and correct, and that I am aware that federal law provides for imprisonment and/or fines for false statements in connection with this form.

I-9 Section 2 — Employer Review and Verification

Step 4 of 5 — Examine original documents presented by the employee

Document Verification Method *

List A — One document establishing both identity AND employment authorization List B + List C — One identity document plus one employment authorization document

List A Document

Document Title *

Issuing Authority *

Document Number *

Expiration Date

Employee's First Day of Employment *

Employer Signature (typed) *

Date *

Employer Title

Employer / Business Name

Direct Deposit Authorization

Step 5 of 5 — Banking information for payroll direct deposit

Account Holder Name *

Bank Name

Routing Number *

Account Type *

Checking Savings

Account Number *

Confirm Account Number *

I authorize Werner Coach Lines, Inc. to initiate credit entries to the bank account listed above and to correct any erroneous entries. This authorization remains in effect until I notify Werner Coach Lines in writing to cancel it.

Employee Signature (type full name) *

Date *

Employment History — Completion Required

The driver's application did not cover 3 years of employment. Add the missing employers below.