Fillable Employee Record Sheet For New Hires printable pdf download

EMPLOYEE RECORD SHEET

For New Hires

Employer/Client Name __________________________________________

SECTION 1: Employee Complete and Sign (please print clearly)

Employee Name _________________________________

Social Security # ___________________

(as shown on SSN card)

Employee Name Change (if applicable) ____________________________________________________

(as shown on SS card)

Address _________________________________________________________________________________________

City ____________________________________________________________ State ____________ Zip ____________

Select

Employee Personal E-mail Address ____________________________________________________________________

Male

Female

Date of Birth _______________

Contact Phone Number _______________________________

Emergency Contact Name _______________________ Relationship _________ Contact Phone Number _____________

NEW EMPLOYEE ONLY: I certify that the information on this form and my employment application and/or resume is true, complete, and correct to the best of my

knowledge and belief. I understand that I may be required to successfully complete a medical exam for initial and continued employment. I further understand that my

employment is at will and agree that it is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time for any reason or

no reason, without prior notice. Neither I nor the employer have agreed on any specific period of employment, nor any specific pay or benefits unless otherwise set forth in a

separate contract. I agree that all claims, disputes and controversies between and among employees and any employee and employer, administrative employer, all agents, or

any other person shall be exclusively and finally settled through the Alternate Dispute Resolution process.

I understand the requirements of this position and acknowledge I am able to perform all essential job functions with or without reasonable accommodations.

Employee Signature: __________________________________________________________ Date _________________

SECTION 2: Employer Complete and Sign (please print clearly)

**New Employee Begin Date: _________________

Client Original Hire Date: _________________

Select

Job Title / Position: ________________________ Department __________ Work State _______

W/C Code ________

Payroll Frequency:

Employee Type:

Schedule:

Regular

On Call