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New Hire Information Form

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TheAstralMerchant
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37 views1 page

New Hire Information Form

Uploaded by

TheAstralMerchant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as ODT, PDF, TXT or read online on Scribd
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New Hire Information Form

This form must be completed for all new employees. Any non-exempt employee working 20 or more
hours per week or any exempt employee must also send in the Benefits Enrollment Form.
Fax this form (or forms) to 916-442-6927, Attn: Benefits
OR mail it to: The Episcopal Diocese of Northern California
Attn: Benefits
350 University Avenue, Suite 280
Sacramento, CA 95825

Congregations and Institutions will be liable for costs associated with insurance that is not correctly processed,
due to this form not being received within 30 days of the date of hire.

This is a fillable form. Click on the box you wish to edit to type. You may also print this form and complete it by hand.

Congregation/ Institution
Name: Clergy/Lay: Clergy Lay

Congregation/ Institution
City: Status: Exempt Non-Exempt
Please also check one of
these boxes: Salaried Hourly

Employee Name Title: Hire Date:

Employee First Name: Hours Per Week:


If the number of hours vary: Under 20 hours per week
20 or more hours per week

Employee Last Name: Annual Salary: $


(total compensation)
Employee Job Title:

Preparer Name: Preparer Job Title:


(Printed Name)
Preparer Signature: Date:

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