This form must be completed by the employer for all new ...
Important: Failure to submit both forms and/or incomplete forms will be returned to the department. Incomplete or missing tax forms will result in the highest withholding from pay.
|ACTION | New Hire Rehire* | |Employee #: | |
| |* City Retiree Y N | |Employee Start Date: | |
| |OBRA Y N | |Last 4 Digits SSN: | |
| |Name: Last | |First: | |M.I. | |
| | | | | |
| | New Position Backfill** |**Prior Incumbent’s Name: | |
| | | | |
| |
|JOB / |Job Class #: | |Job Title: | |
|SALARY | | | | |
| |Location: | |Grp Bargaining Unit/Union: | |
| |Reports to: | |Shift: | |Standard Hrs: | |
| | Full Time Part Time | |Civil Service: Y N |
| |Class: | Permanent Temporary Seasonal |
| | | Emergency Provisional Intermittent |
| |Employee Type: | Hourly/Non Exempt Salaried/Exempt |
| |Salary Plan / Grade: | | |
| | General Fund Grant Fund | | |
| |Org: | |Obj: | |Proj: | |
| |Start Date: | |End Date: | | |
| |Pay Rate: |Hourly: |$ |Weekly: |$ |Annual: |$ |
| |Addl Licenses: | 725/726 CDL 768/770 Pesticide 727/728 Construction |
| |Check Location: | | | |
| | | | | | | | |
| |
|TLM INFO |TLM Dept: | |Person Type: | |
| |Pay Rule: | |Accrual Profile: | |
| |Badge #: | | | |
| | | | | |
| |
|COMPANY |Date Assigned: | | | |
|EQUIPMENT | | | | |
| |Description of Items/Type: | |
| | | |
| | | |
| | | | | |
|APPROVALS |Manager Signature: | |Date: | |
| |Manager Name (Print): | | | |
| |Finance – Financial Analyst: | |Date: | |
| |Finance Director – TIMOTHY J PLANTE | |Date: | |
| |Budget Director – LEANN PASQUINI | |Date: | |
| | | | | |
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EMPLOYER NEW HIRE / REHIRE FORM
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