New Employee Information Form
:PAYROLL USE ONLY :
Hrs
The following information must be completed and submitted to Human Resources before an
employment contract/agreement, insurance forms, or payroll forms can be completed.
HR USE ONLY
Birthdate
Social Security #
Salutation:
Mr.
Ms.
Mrs.
Dr.
ID#
Street Address
City
State
________
Sick
________
Vac
________
 PPAIDEN
 PEAEMPL
 NBAJOBS
 PDABDSU/DEDN
 GXADIRD
 PEALEAV
Rev.
Name
Pers
Zip
 Address book
 Attendance
 HPS / PFL
 Timesheet sent
 LST waived
Home Phone
Date of Employment
Title(s)
Replacement for
Workdates
(Please list only if employee is not a 12 month employee. Example: 10-month employee may have work dates of 8/15/06 – 6/15/07)
Full Time
Campus:
Part Time # Months
Grantham
Harrisburg
# Weeks
# Hours/Week
Winding Hill
Online
Total Hours
Other Office Bldg/Room:
School/Department/Assignment
Work Supervisor(s)
Band (for admin/staff employee)
Salary Range (for admin/staff employee)
Wage/Salary $
Account #1
%
Account #3
%
Account #2
%
Account #4
%
COE Status
(academic)
Term-Tenure
Clinical Track
Lecturer
Visiting
Emeriti
Curricular Administrator
Cocurricular Educator
COE Associate
Librarian
Not Faculty or Other COE Member
Is this individual a former Messiah College student?
Is this individual previously affiliated with the College?
Yes
Scholar/Artist in Res.
Adjunct
Paraprofessional
Coach
No
Yes
No
Explain?
Director/Dept Chair
Date:
Vice Provost / Dean
Date:
Provost/VP
Date:
VP for HR
Date:
Print Name
HR Use Only:
Document1
FLSA Timesheet Req’d
Copies to:
Signature
HR
Benefits
Payroll
Criminal Background
Revised 08/2016