A wage levy requires an Application for Earnings Withholding Order instead of a letter of instruction. Use Form 590, Withholding Exemption.Certificate, to certify an exemption from nonresident withholding. Completing the Form: Fill in your full name, home address,. Social Security number, and the identification number (if any) of the pension or annuity. Instructions to the Applicant. The information you provide in this Personal History Statement will be used in the background investigation. The following is a list of some documents that may be recorded if they meet all requirements, and a description or definition of each document. State income tax withholding (only required if withholding differs from your federal withholding amount). Contra Costa Water District is seeking independent contractors interested in educating students about the importance of water service and related subjects.