Remote Hire Authorized Agent Notice Instructions (Page 2 of 2) in pdf

Remote Hire Authorized Agent Notice Instructions Page 2

REMOTE HIRE AUTHORIZED AGENT NOTICE FORM

EMPLOYEE INFORMATION:

_______________________________

_________________________M.I. ____

NAME: LAST

FIRST

__________________

DATE OF BIRTH

UC DEPARTMENT INFORMATION – THIS SECTION IS TO BE COMPLETED BY THE HIRING DEPARTMENT ONLY.

DEPT CONTACT LAST, FIRST NAME _______________________________________________________

DEPT CONTACT TITLE __________________________________________________________________

DEPT CONTACT PHONE NO. (

)______________________________________________________

UC CAMPUS & DEPT NAME _______________________________________________________________

UC CAMPUS ADDRESS:__________________________________________________________________

CITY: ________________________________ STATE: ________ ZIP CODE: _______________________

PLEASE CHECK WHICH FORMS MUST BE COMPLETED BY THE AUTHORIZED AGENT:

(

) I-9 Form

(

) Oath

(

) Patent

EMPLOYEE’S DATE OF HIRE ____________________ (THIS DATE MUST BE ENTERED INTO THE CERTIFICATION

SECTION OF THE I-9 FORM AND/OR EMPLOYMENT DATE SECTION OF THE OATH BY THE AUTHORIZED

AGENT).

_______________________________________________________

______________________

DEPARTMENT CONTACT SIGNATURE

DATE

NOTARY: CHECK WHICH FORMS ARE BEING NOTARIZED AND PLACE NOTARY SEAL IN THIS SECTION OR

ATTACH NOTARY CERTIFICATE.

(

) I - 9 Form

(

) Oath

(

) Patent

THIS FORM MUST BE COMPLETED AND GIVEN TO THE AUTHORIZED AGENT BEFORE THE I-9 FORM AND/OR THE OATH IS

COMPLETED. THIS WILL ENSURE THAT THE HIRE DATE LISTED ON THE FORMS IS PROVIDED AND VERIFIED BY THE

HIRING DEPARTMENT. DEPARTMENTS PLEASE ATTACH THE COMPLETED FORM(S) (WITH ORIGINAL SIGNATURE AND

DATE) TO THE NOTICE AND RETURN ALL FORMS TO PAYROLL SERVICES.

Remote Hire Authorized Agent Notice Instructions Page 2