Employee Report Form New Hire, Rehire, Or Reactivated Employee

Employee Report Form – New Hire, Rehire, or Reactivated Employee

Check type of change below:Effective date: Click here to enter a date.

☐New hire☐Rehire

☐Reactivate (casual/seasonal/temporary employee within 1 year from last period of employment)

COMMENTS: Click here to enter text.

Legal name Enter Last Name, Enter First Name Enter Middle Initial.Department:Choose an item.
Reactivated/rehire employee # Click here to enter text. / ☐ Regular full-time
Position # Click here to enter text. / ☐Regular part-time
Payroll Occ. Code # Click here to enter text. / ☐Casual/seasonal/temporary
Class Title Click here to enter text. / ☐ Work study program
General ledger acct(s):
Click here to enter text. Click here to enter text.%
Click here to enter text. Click here to enter text.% / Hours per pay period Click here to enter text.
Click here to enter text. Click here to enter text.% / % of full-time (3 digits max) Click here to enter text.
Click here to enter text. Click here to enter text.%

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COMPLETE THIS SECTION FOR NEW EMPLOYEES OR TO PROVIDE UPDATED INFORMATION FOR REACTIVATED

EMPLOYEES:
Mailing Address: Click here to enter text. / ☐ White
Primary phone number: Click here to enter text. / ☐ Asian
Birth date: Click here to enter text. / ☐ Hispanic or Latino
Sex☐Male☐Female / ☐ Black or African
☐ Native Hawaiian or other Pacific Islander
Seasonal hourly rate: $Click here to enter text. / ☐ American Indian or Alaska Native
☐ Two or more races

COMPLETE FOR REGULAR EMPLOYEES ONLY:

Pay level/step Click here to enter text.Hourly $Click here to enter text.

☐Exception pay☐Positive Pay Name of Incumbent: Click here to enter text.

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DEPARTMENTS: Please attach the following completed documentation for casual/seasonal/temporary new hires if available:

•Federal W-4 form•State WT-4 form (required only if deductions/$ are different than federal form)

•Copy of Social Security card•I-9 Form•Direct deposit authorization agreement

•Voided check from checking account or deposit slip from savings account for payroll direct deposit

INACTIVE EMPLOYEES RETURNING TO ACTIVE STATUS: If there are any changes to any of the information above, new forms and/or Social Security card is required. If name, address, phone, tax deduction choices, direct deposit, and personal information haven’t changed, returning employees do not need to complete these.

☐Check here if no changes to previous payroll information for reactivated employee.

ERF deadline: Forms are due in Employee Resources at 1 p.m. the Thursday prior to the start of the payroll period when the change will occur.

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I VERIFY THIS INFORMATION IS CORRECT:

Department head/designee signature or typed name Click here to enter text.Date Click here to enter a date.

Final review by Employee Resources Department Click here to enter text.Date Click here to enter a date.

Payroll use only:

Person #: ______Group # ______New employee # ______☐Payroll ☐Emp. personnel file

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