Employee New Hire Setup Form

Employee New Hire Setup Form

A. Company / Administrative

Company Name:

HR Contact:    Phone:

B. Personal Information

Primary phone:    Email:

Date of birth:    Social Security Number:

Relationship:    Phone:

C. Position & Employment Details

Reporting manager:    Work location:

Employment type: Full-time   Part-time   Temporary/Seasonal   Contractor

FLSA status: Exempt   Non-exempt

Start date:    Standard hours/schedule:

Pay type: Salary   Hourly

Pay frequency: Weekly   Bi-weekly   Semi-monthly   Monthly

D. Payroll & Banking

Direct deposit: I authorize direct deposit of pay to the account listed below. I will notify payroll of any changes.

Routing number:    Account number:

Account type: Checking   Savings

E. Benefits Enrollment (Initial selections)

Select benefits to initiate enrollment. Enrollment is subject to plan terms and eligibility.

Medical   Dental   Vision   401(k) / Retirement

F. Equipment & Access Requests

Please indicate required equipment and system access for the position.

Company email   VPN   HRIS   Payroll system

ID badge   Laptop   Desktop   Mobile phone

G. Employment History (most recent first)

Title:    From: To:

Title:    From: To:

H. Education & Certifications

Institution:    Graduation date:

I. Professional References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

J. Legal Disclosures, Authorizations & Acknowledgments

At-Will Employment. I understand and acknowledge that, unless otherwise provided in a separate signed agreement, my employment is at-will, which means either I or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Opportunity. The employer provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other protected characteristic as defined by applicable law.

Authorization to Verify Information and Background Checks. I authorize the employer and its agents to verify all information provided on this form and to obtain and review my employment history, education records, and any criminal, credit (where job-related), motor vehicle, and other background information as permitted by law. I release all previous employers, educational institutions, and other persons from liability in responding to inquiries in connection with this authorization.

Check to indicate consent: I consent to background and reference checks as described above.

Confidentiality and Proprietary Information. I acknowledge my obligation, both during and after employment, to comply with the employer’s policies concerning confidential, proprietary and trade secret information, and I understand that unauthorized disclosure may result in disciplinary action up to and including termination and potential legal action.

K. Applicant Certification

I certify that all information provided on this form is true, complete and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may disqualify me from employment or be grounds for discipline or termination if discovered after hire. I authorize the employer to rely on this information and to contact the persons or organizations referenced herein.

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