Please enable JavaScript in your browser to complete this form.Mandatory for Office Use: This Form Must Be Filled Out by Hiring Manager Prior to Submitting for Processing.Employee Work Location: *Rate of Pay: *Start Date: *# of Hours per Week (Select One): *Full TimePart TimeWork Schedule (Check All that Apply): *MondayTuesdayWednesdayThursdayFridaySaturdaySundayAMPMHas the employee provided a cell/mobile phone number? *YesNoHas the employee provided a valid email address? *YesNoHas the employee filled out both federal and state W-4 tax forms? *YesNoHas the employee filled out the I-9 Form completely and dated and signed it? *YesNoHas the employee provided you with current employment identification and is it attached to the application? *YesNoHas the employee filled out the Health Insurance Form either accepting or declining insurance? *YesNoHas the employee filled out the Direct Deposit Form with bank and account information OR requested a paycard? (It is mandatory for the employee to select one or the other of these options.) *YesNoHas the employer signed and dated the Employee Handbook Form and the Approval for Background Check? *YesNoHas the manager filled out the Employer I-9 Form and signed and dated it? *YesNoSupervisor's Signature: * Clear Signature Date: *Name: *FirstLastEmail: *Submit
