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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