Enter the name, address, and phone number of your employer. If you do not know the exact name or address, enter as much information as you know.
Enter the date you started your job. If you don’t know the exact date, enter your best guess.
Select your pay period. Most people get paid weekly, bi-weekly (every two weeks), twice a month, or monthly. If you get paid differently, choose Irregular. .
If you are paid hourly, enter the amount you earn per hour and the number of hours you work each week.
If your hours per week are not the same each week.
Pay Period Amount
Enter your total gross pay. This can be found on your most recent paystub.
Irregular (Per Diem)
If your receipt of income from sporadic short-term employment or you
get paid daily, but is on call and do not have a standard amount of pay you should select Irregular pay.
Contractual/Single Payment Covering More than One Month
If you are paid after you have finished a job or during stages of completion of a job. Payments made at intervals greater than one month subject to arrangements made between the payer and payee Ex. If you get paid when the job it one third complete, half complete, etc.
Enter the gross pay you earn each pay period. Gross payment is the amount you earn before taxes or anything else is taken out of your paycheck.
Enter information about overtime, holiday or weekend pay. Enter the number of hours you work. If you receive other income, estimate the amount of pay that you get. For example, if you get a $100 bonus every month, divide $100 by 4 to get $25 bonuses each week.
If the hours you work overtime, holidays, or weekends change each week, enter an average number of hours you work at each rate.
Bonus or Commission/Tip Pay
For tips or commissions, estimate on average the amount you receive weekly. For example, if you receive $50 in tips twice a week as a waiter, you receive $100 in tips weekly.
If the person has another job, select Yes. Enter information about the additional job the same as you did for the first job.
To close this window and return to ConneCT without saving, click the CANCEL & EXIT button.