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Please list all the names of your present or previous employers(past 7 years only) in choronological order with present of most recent employer listed first. Be sure to include ALL periods of time including any period of unemployment. If-self employed, give firm name and supply business references.

Most Recent

Employer 2

Employer 3

Employer 4

Every employee, on or before the date of commencement of employment, shall furnish his or her employer with a signed Alabama withholding exemption certificate relating to the number of withholding exemptions which he or she claims, which in no event shall exceed the number to which the employee is entitled. In the event the employee inflates the number of exemptions allowed by this Chapter on Form A4, the employee shall pay a penalty of five hundred dollars ($500) for such action pursuant to Section 40-29-75.
1. If you claim no personal exemption for yourself and wish to withhold at the highest rate, write the figure "0"
2. If you are SINGLE or MARRIED FILING SEPARATELY, a $1,500 personal exemption is allowed. Write the letter "S" if claiming the SINGLE exemption or "MS" if claiming the MARRIED FILING SEPARATELY exemption
3. If you are MARRIED or SINGLE CLAIMING HEAD OF FAMILY, a $3,000 personal exemption is allowed. Write the letter "M" if you are claiming an exemption for both yourself and your spouse or "H" if you are single with qualifying dependents and are claiming the HEAD OF FAMILY exemption
4. Number of dependents (other than spouse) that you will provide more than one-half of the support for during the year. See dependent qualification below
5. Additional amount, if any, you want deducted each pay period
DEPENDENTS: To qualify as your dependent (Line 4 above), a person must receive more than one-half of his or her support from you for the year and must be related to you as follows:
  • Your son or daughter (including legally adopted children), grandchild, stepson, stepdaughter, son-in-law, or daughter-in-law;
  • Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in-law;
  • Your brother, sister, stepbrother, stepsister, half-brother, half-sister, brother-in-law, or sister-in-law;
  • Your uncle, aunt, nephew, or niece (but only if related by blood).
Personal Allowances Worksheet
A. Enter "1" for yourself if no one else can claim you as a dependent
Enter "1" if:
  • You are single and have only one job; or
  • You are married, have only one job, and your spouse does not work; or
  • Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less.}
C. Enter "1" for your spouse. But, you may choose to enter "-0-" if you are married and have either a working spouse or more than one job. (Entering "-0-" may help you avoid having too little tax withheld.)
D. Enter number of dependents (other than your spouse or yourself) you will claim on your tax return
E. Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above)
F. Enter "1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit. (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
G. Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
  • If your total income will be less than $70,000 ($100,000 if married), enter "2" for each eligible child; then less "1" if you have two to four eligible children or less "2" if you have five or more eligible children.
  • If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each eligible child
H. Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.)
For accuracy, complete all worksheets that apply.
  • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2.
  • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.
Deductions and Adjustments Worksheet
1. Enter an estimate of your 2016 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1952) of your income, and miscellaneous deductions. For 2016, you may have to reduce your itemized deductions if your income is over $311,300 and you are married filing jointly or are a qualifying widow(er); $285,350 if you are head of household; $259,400 if you are single and not head of household or a qualifying widow(er); or $155,650 if you are married filing separately. See Pub. 505 for details
2. Enter:
  • $12,600 if married filing jointly or qualifying widow(er)
  • $9,300 if head of household
  • $6,300 if single or married filing separately}
3. Subtract line 2 from line 1. If zero or less, enter "-0-"
4. Enter an estimate of your 2016 adjustments to income and any additional standard deduction (see Pub. 505)
5. Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2016 Form W-4 worksheet in Pub. 505.)
6. Enter an estimate of your 2016 nonwage income (such as dividends or interest)
7. Subtract line 6 from line 5. If zero or less, enter "-0-".
8. Divide the amount on line 7 by $4,050 and enter the result here. Drop any fraction
9. Enter the number from the Personal Allowances Worksheet, line H, page 1
10. Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1
Two-Earners/Multiple Jobs Worksheet (Note: Use this worksheet only if the instructions under line H on page 1 direct you here.)
1. Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
2. Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than "3"
3. If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter "-0-") and on Form W-4, line 5, page 1. Do not use the rest of this worksheet.
Note: If line 1 is less than line 2, enter "-0-" on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill.
4. Enter the number from line 2 of this worksheet
5. Enter the number from line 1 of this worksheet
6. Subtract line 5 from line 4
7. Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here.
8. Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed
9. Divide line 8 by the number of pay periods remaining in 2016. For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2016. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9