Medicare Tax Eligibility Form - River Parishes Community College (Page 2 of 4) in pdf

Medicare Tax Eligibility Form - River Parishes Community College Page 2

RIVER PARISHES COMMUNITY COLLEGE

CONFIDENTIALITY OF HOME ADDRESS AND PHONE NUMBER

Section 1.R.S.44.11 is hereby amended and reenacted to read as follows:

11.

Confidential nature of certain personnel records

Notwithstanding anything contained in this Chapter or any other law to the

contrary, the following items in the personnel records of public employees of

any public body shall be confidential:

1) The home telephone number of the public employee where such employee

has chose to have a private or unlisted home telephone number because of

the nature of his occupation with such body.

2) The home telephone number of the public employee where such employee

has requested that the number be confidential.

3) The home address of the public employee where such employee has

requested that the address be confidential.

Please indicate below if you wish your home telephone number and/or home address to

be confidential.

Yes

I want my home telephone number to be regarded as confidential

in accordance with R.S. 44.11.

Yes

I want my home address to be regarded as confidential in

accordance with R.S. 44.11.

I understand that, if at any time I want to change the above indicated status, I must submit

a revised copy of this form to the Human Resource Department.

Employee Name (Please print)

Social Security Number

Employee Signature

Date

Please note: Failure to return this form to the Human Resource Department will result in this office considering your

home address and telephone number as public information.

Medicare Tax Eligibility Form - River Parishes Community College Page 2