Payroll / Status Change Notice Form - Duchesne County, Utah Page 2
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2New Hire Checklist
Policy Acknowledgement
Drug Test Results
Physical Test / Evaluation
Returned
I-9
W-4
Employee Data
Driver License
Background Check
State New Hire Report
E-Verify Report
FMLA Info Sheets
EEO Info
Internship / Probationary
Worker’s Compensation /
Worker’s Comp Class
Extension
Accident Reporting
#
Educational Assistance
Offer Letter
Sworn-in
Time Sheets
Medical Form
Retirement Form
Vacation
Dental Form
Retirement Ineligible Form
Sick Leave
Life, STD, LTD, Form
401k / 457 / IRA / Roth IRA
Holidays
Insurance Waiver
Retirement Booklet
Check- Mail / Pick-up /
Enrollment Guide / Benefit
ID Badge
Deposit / Sheriff’s office
Guide
Payroll Change Checklist
Wage &/or Hours Increase / Lincoln Notified /
Dept Change / Employee Number Changed /
Changed on Caselle
Allocation Changed
Leave of Absence / Retirement Notified
Termination Checklist
Credit Card Returned/Cancelled
Telephone Card Returned/Cancelled
Keys (office, desk, etc.) Returned
Safety Equipment Returned
Equipment/Tools Returned
Health Cancelled
Retirement Notification
Dental Cancelled
Conversion (life, std, ltd) Notification
Life, STD, LTD Cancelled
COBRA – Notify R Hussey’s Office
Reimbursement Owed to County
11/2012
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