Out Of State Hire Preliminary Questionnaire

Name of Hire: 
Job Title:
City, State Zip:
Anticipated Date of Hire:
Estimated Salary:
Resident State:
Work State:
Brief description of work to be performed:

IMPORTANT: The majority of states impose a state income tax. Employees working in these states may also be subject to additional taxes such as city, county, school district, disability, and unemployment withholding taxes. Employers are also subject to payroll tax expenses such as unemployment, disability, and head count taxes. States vary in their requirements to register to do business in their state. Additional information may be needed to complete the state business registration. Please list the name of the FAU contact person who can be reached for additional information.


FAU Department Contact Person


Submit completed questionnaire to:
Payroll Department
Controller’s Office/Payroll
Ph: 561-297-6401
Fax: 561-297-1062

Revised 03/14/14
send any comments to Krisa Kolbe

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 Last Modified 5/7/14