Employee Master Data Sheet printable pdf download

Employee Master Data Sheet

/ S

ETURNING PART

TIME

UMMER EMPLOYEE

MASTER DATA SHEET

*If employee last worked over 1 yr ago, obtain new hire packet from HR, otherwise complete the following:

Employee Name: ___________________________________________________________

Address: _________________________________________________________________

Phone: ______________________

Email: ___________________________________

Emergency Contact: ______________________________________Phone: ____________

Address: __________________________________________________________________

**ATTENTION SUPERVISOR

Returning employee MUST COMPLETE THE FOLLOWING FORMS:

__ CORI Form with Driver License/Picture ID

__ Acknowledgment of Receipt of Employee Handbook (2012-2013)

SUPERVISOR & RETURNING EMPLOYEE –REVIEW THE FOLLOWING

Federal Withholding

__________ NO CHANGE employee’s initials confirm no change

__CHANGE (attach W-4)

State Withholding

__________ NO CHANGE employee’s initials confirm no change

__CHANGE (attach M-4)

Direct Deposit

__________ NO CHANGE employee’s initials confirm no change

__CHANGE (attach direct deposit form)

*NAME CHANGE - COMPLETE NEW I-9

Choose one of the following by putting your initials on the applicable line

Retirement

(1)_____ I am currently receiving a retirement pension and do not need retirement withheld.

(2)_____ I currently contribute to a state retirement plan and do not need retirement withheld.

(3)_____ I do not qualify for (1) or (2), enroll me in OBRA

(Attach OBRA Enrollment Form).

ADDITIONAL ITEMS REQUIRED:

EMPLOYEE SIGNATURE / DATE: ________________________________ / __________________

MANAGER SIGNATURE / DATE: __________________________________ / ________________

MAIL OR FAX TO:

Collaborative HR, 97 Hawley St. Northampton, MA 01060 / FAX 413-584-8217

Employee Master Data Sheet