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Employer Complete
Employer Complete
New Hire
Rehire
Previous Name
Employment Data
Job title
Date of Hire
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Grade
Pay Checkbox
Hourly
Salaried
Full-time
Part-time
Seasonal - Scheduled Days and Hours
Description
Supervisor/Manager Signature
Date
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Employee Complete
Personal Data
Full Name
*
First
Last
Initial
Address
Address Line 1
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Telephone Number
*
Date of Birth
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Date of Birth
Personal Email Address
Emergency Contact Information
Name
Relationship
Emergency Telephone Number
Employee signature
*
Date
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Name
Submit