NEW HIRE ORIENTATION

BENEFITS

NEW HIRE CHECK LIST

PERSONNEL INFORMATION

NAME: _____________________________________________

ADDRESS:______________________________________________

____________________________ _____________ _______________________________ CITY STATE ZIP

MARITAL STATUS: ( ) SINGLE( ) MARRIED ( ) DIVORCED ( ) WIDOW

SEX: MALE_____________ FEMALE_______________

ETHNIC CODE: AMERICAN INDIAN OR ALASKA NATIVE _________

ASIAN _________

BLACK OR AFRICAN AMERICAN _________

NATIVE HAWAIIAN OR OTHER PACIFIC RACE _________

WHITE OR CAUCASIAN _________

HISPANIC

DATE HIRED: __________________ DATE OF BIRTH _________

PHONE: ___________________

EMPLOYMENT PERIOD _________(10,11,12,P)

TITLE OR JOB DESCRIPTION _____________________________________________

SCHOOL OR LOCATION _____________________________________________

GRADE _________ SUBJECT __________________

Work Email

Alt. Email

SOCIAL SECURITY NUMBER ________ __________ _____________

PERSONNEL INFORMATION

STATE TAX FORM

W-4 FEDERAL TAX FORM

WORKERS COMP. PROCEDURES

DRUG FREE AKNOWLEDGEMENT

EMPLOYEE ACKNOWLEDGEMENT

I have received information relative to the Drug Free Work Place Act of 1988 and the Drug Free Schools and Communities Act of 1989 and understand that my adherence to this policy is mandated by the Crisp County Board of Education. Violation of this policy will result in disciplinary action(s). I understand that any conviction for a drug-related offense must be reported by written notification to the Superintendent of Schools within five (5) calendar days following disposition by the court. __________________________ Employee Signature

___________________________ Printed Name ____________________________________ Date

DIRECT DEPOSIT FORMCrisp County School System

Direct Deposit Authorization Form

__________________________________________ _________________________ Employee Name (Please Print) Social Security Number ___________________________________________________ School/Location _________________________________________ ____________________________________ Name of Financial Institution/Bank City, State Financial Institution/Bank Routing Transit Number ___ ___ ___ ___ ___ ___ ___ ___ ___ (Look between symbols /: and /: on bottom left corner of your check) Checking Account Number ________________________________________ OR Savings Account Number ___________________________________________ I hereby authorize the Crisp County School System to initiate a CREDIT entry to my checking/savings account at the Bank or Financial Institution I have listed above and initiate adjustments, if necessary, for any transactions credited or debited in error. This authority will remain in effect until I, the employee, notify the payroll department in writing to cancel it. ___________________________________________ Employee Signature ___________________________________________ Date

PLEASE ATTACH A VOIDED CHECK HERE

ms 04/07

Link to State Health Decision Guide

http://bcove.me/py40gpsy

SECURITY/CONFIDENTIALITY

CRISP COUNTY SCHOOL HANDBOOK

CHILD ABUSE OR NEGLECT

AMERITAS GROUP INSURANCENOEL WILLIAMS/JOEL OWENS

LIFE INSURANCE CO. OF ALABAMASTEPHANIE KINNEBREW

CAFETERIA PLAN ELECTION

FLEXIBLE SPENDING ACCOUNT

STANDARD LIFE

ASSURANT EMPLOYEE BENEFITSRICK GROOVER

ASSURANT EMPLOYEE LIFE RATES

ASSURANT SPOUSE RATES

 

ASSURANT DISABILITYRICK GROOVER

PLAN 1

PLAN 2

PLAN 3

PLAN 4