Revised 06/21

CITY OF ARLINGTON NEW EMPLOYEE PROCESSING PROCEDURE

INSTRUCTIONS TO NEW EMPLOYEES: Welcome to the City of Arlington! Below you will find instructions for completing necessary new employee paperwork, and you will receive a scheduled time to report to the Human Resources Office to receive your Employee ID Badge, welcome gift bag and to complete final processing for your first day. The Human Resources Office is located at 101 S. Mesquite St, Suite 790, Arlington, TX 76010.

YOU ARE REQUIRED TO ARRIVE WITH THE FOLLOWING MATERIALS IN HAND:

Your completed New Employee Orientation Packet (all of the forms in this document).- Please complete all forms prior to your arrival in Human Resources.

Your Confirmation of Employment Letter, which states your salary and position information.

Your documentation that will establish both identity and employment eligibility.- Please refer to the "List of Acceptable Documents" located on page 3 of this packet foracceptable documentation. Prospective employees who do not have these documents must obtain areplacement before being hired. If a receipt is presented, you must bring in the actual document oncereceived.

Your Beneficiary/Dependent Information List:You are eligible for the health, dental, vision and life insurance coverage offered by the City,and will be enrolled in the City’s retirement program. At the time of processing, you will beasked to make a decision on the plan that best suits the needs of you and your family. You mustdesignate a beneficiary for some of these benefits. Please bring the following information onyour beneficiaries and any dependents you plan on enrolling on the insurance plans. Accurate andcomplete data will ensure timely enrollment.

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Revised 06/21

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)

1. U.S. Passport or U.S. Passport Card

3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machine-readable immigrant visa

4. Employment Authorization Documentthat contains a photograph (FormI-766)

5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:

Documents that Establish Both Identity and

Employment Authorization

6. Passport from the Federated Statesof Micronesia (FSM) or the Republicof the Marshall Islands (RMI) withForm I-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMI

b. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;

and(2) An endorsement of the alien's

nonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.

a. Foreign passport; and

For persons under age 18 who are unable to present a document

listed above:

1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address

9. Driver's license issued by a Canadiangovernment authority

3. School ID card with a photograph

6. Military dependent's ID card

7. U.S. Coast Guard Merchant MarinerCard

8. Native American tribal document

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish Identity

LIST B

OR AND

LIST C

7. Employment authorizationdocument issued by theDepartment of Homeland Security

1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:

2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)

3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal

4. Native American tribal document

6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)

Documents that Establish Employment Authorization

5. U.S. Citizen ID Card (Form I-197)

(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION

(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3Form I-9 10/21/2019

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

CITY OF ARLINGTON

BADGE PICTURE INSTRUCTIONS AND REQUIREMENTS

• Must be a current photo

• Stand in front of a plain light background.

• Make sure you have proper lighting.

• Face the camera directly to provide a full-face photo. — selfies aren’t acceptable.

• Make sure your photo meets all the requirements in regard to your expression, pose, hair,

etc. (details below).

• Hair should be well groomed

• A neutral expression or smile is acceptable

• Cannot have on sunglasses or hats.

• Head coverings due to religious beliefs are acceptable

If you do not know if the Building Access card is required, please leave that blank.

Once you have taken the photo, please email the photo to: newemployeeinfo@arlingtontx.gov

Subject: Your First and Last Name (as it is listed on your current social security card)

02/2022

CITY OF ARLINGTON ID BADGE INFORMATION SHEET

Please fill out the information below, and bring a photo ID for cross identification. If you currently have a City ID, please bring it with you to the Human Resources Department. Name: _________________________ Job Title: _________________________ Department: _________________________ DOOR ACCESS CARD REQUIRED: Yes ☐ No ☐ There will be no height measure at the badge making sites. Please provide your best estimate of height. Height: __________ Eye Color: __________ Hair Color: __________ The ID Badge provided to you is the property of the City of Arlington. Upon leaving employment with the city, you must return your ID. Should your ID Badge expire or become significantly worn, you may exchange it for a new badge at no cost. Employee cost to replace a lost badge is $10. __________________________________________ _______________________ Employee Date

This information will be listed on the back of the card.

City of Arlington Terminal Pay Beneficiary Designation

I _________________________ with Kronos ID# ______________, understand that in the

event of my death, my wages or other types of pay (i.e. final regular pay, overtime pay, holiday

pay, sick and vacation leave hours, stability pay, current base pay for 2 pay periods, ETC) will be

paid to the person designated by me on this form. In this regard, I authorize the City of Arlington

to make my final paycheck payable to the person designated by me on this form. Pursuant to

the requirements of Vernon’s Texas Probate Code Section 450, I convey my final paycheck to:

I understand that this written form will convey my final paycheck outside of my Last Will and

Testament, if I have a Will, or outside of the intestacy statutes, if I do not have a will. Therefore,

no persons other than the person listed above shall have any right to my final paycheck and will

not be able to obtain this money from the City of Arlington.

Employee Signature: _________________________________ Date: ____________________

*Privacy Act of 1974 Disclosure: Authority: Finance Payroll & Human Resources, City of Arlington. Routine Users:

The SSN is used to verify identity and to track persons in various systems. Disclosure: Voluntary. However, failure

to furnish SSN may result in delay in processing this form.

_____________________________________________________________ ______________________ First Name Middle Name Maiden Name Last Name Relationship

__________________ _________ ________ ____________________ PRIMARY or SECONDARY

Phone Number Date of Birth *Social Security Number ↑ Circle Beneficiary Type ↑

_______________________________________________________________________________________ Address City State Zip Code

_____________________________________________________________ ______________________ First Name Middle Name Maiden Name Last Name Relationship

__________________ _________ ________ ____________________ PRIMARY or SECONDARY

Phone Number Date of Birth *Social Security Number ↑ Circle Beneficiary Type ↑

_______________________________________________________________________________________ Address City State Zip Code

09/2019

City of Arlington EEO Supplemental Information

The City is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we ask that you complete this form. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse action. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. This information will not be used to make any employment decision including, but not limited to promotions, transfers or demotions.

Gender □ Female□ Male

Disability □ No□ Yes

Veteran Status □ Vietnam Era Veteran□ Special Disabled Veteran□ Other Eligible Veteran□ Not a Veteran

Race/Ethnic Origin □ American Indian or Alaska Native□ Asian□ Black or African American□ Hispanic or Latino□ Native Hawaiian or Other Pacific Islander□ Two or More Races□ White

Date

_____________________________________ Employee Name - Printed

_____________________________________ Employee Signature

12/2016

12/2015

CITY OF ARLINGTON

AT-WILL EMPLOYMENT

Please make yourself aware of the following employment policy noted in the City of Arlington’s

Personnel Policy:

105.04 DISMISSAL

A. “At-will” employees, as listed in Appendix D to Chapter 101.00 (probationary, part-

time, seasonal, or temporary employees, council appointees, Deputy City Managers,

department heads, assistant city attorneys, the heads of organizational units, and persons

in other specific positions identified in Appendix D to this Chapter, and those other

employees designated at the time of hiring/promotion by the City Manager as "at will"

employees) may be transferred, demoted, or dismissed from city employment at any time,

with or without cause. Such employees have no property interest in continued

employment with the City, and their dismissal is not appealable.

I _________________________, have read the above City of Arlington employment policy and

understand that I may be dismissed from my duties as an “at-will” employee with the City of

Arlington at any time and without cause.

Signature Date

CITY OF ARLINGTON

OPEN RECORDS AND YOUR PERSONAL INFORMATION

The Texas Public Information Act says that any person may ask to view or receive copies of any information held by the City. Most of the City’s information is public, meaning the City will release the information upon request. However, certain information is not public and will not be released.

You may choose to keep the following information about yourself private (meaning it will never be released under a Public Information Act request):

• Home address• Personal phone numbers• Social security number• Emergency contact information• Any information that reveals whether you have family members

If you want to keep this information private, then you must sign the statement below and return this form to the City’s Human Resources Department. If you do not sign and return this form, then your information may be released under a Public Information Act request.

(Note: Certain other information about you is always private, even if you do not complete this form. For example, the City will never release your optional insurance elections, private medical information, or other information considered confidential under state or federal law.)

I choose to keep my home address, personal phone numbers, social security number, emergency contact information, and information that reveals whether I have family members private. I do not want any of this information released under a Public Information Act request.

Printed name ___________________________

Signature ___________________________

Employee ID # ___________________________

Date ___________________________

09/2016

New Member Form

MeMber INForMatIoN

Please type or use only black ink and do not highlight. Any corrections must be initialed.

TMRS Identification Number (not required)

Member’s Name (first, middle, last) Social Security Number

Mailing Address Daytime Phone Number

City State Zip City Name

Sex: q Male q Female

Date of Birth (MM/DD/YYYY) Gross Monthly Salary Date of Participation TMRS City Number

Check one if applicable: Uniformed q fire q police OR Non-uniformed q fire q police

If you are a member of any of the following systems, please check the appropriate box(es): q Texas Municipal Retirement System q Texas County and District Retirement System q Teacher Retirement System of Texas

q Employees Retirement System of Texas q City of Austin Employees Retirement System q Judicial Retirement System of Texas

beNeFICIary DesIgNatIoN (LIMIt 3)Please read instructions before completing. This beneficiary designation will not control in the event you are or become vested.

Beneficiary’s Full Name (first, middle, last) Social Security Number

Sex: q Male q Female Relationship (required) Date of Birth (MM/DD/YYYY)

Beneficiary’s Full Name (first, middle, last) Social Security Number

Sex: q Male q Female Relationship (required) Date of Birth (MM/DD/YYYY)

Beneficiary’s Full Name (first, middle, last) Social Security Number

Sex: q Male q Female Relationship (required) Date of Birth (MM/DD/YYYY)

CUstoDIaN UNDer the texas UNIForM traNsFers to MINors aCtYou may designate a custodian if any beneficiary is under 21 years of age.

Custodian’s Name (first, middle, last) Custodian’s Relationship to Beneficiary

MeMber sIgNatUre reqUIreDI request that if I die before becoming vested, my account balance and any Supplemental Death Benefits that may be due be paid to the person(s) listed above. Should I, at some future time, decide to have my account balance paid to someone other than the person(s) listed above, I will make the change in writing on a form prescribed by TMRS. If a beneficiary named above predeceases me and I fail to name another beneficiary, or in the event my relationship with said beneficiary ceases, then this designation shall become inoperative as to that beneficiary. I understand that if I name more than one primary beneficiary, my account balance will be paid to the surviving primary beneficiaries in equal shares (unless I have otherwise directed on this form). By signing this form, I certify that I have read the attached instructions.

Member’s Signature Date Signed (MM/DD/YYYY)

Please read the information provided on the reverse side of this document.

TMRS • P.O. Box 149153 • Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www.tmrs.com *TMRS0016*TMRS - 0016 • Revised 7-2009

beNeFICIary NoteshoW LoNg Is the beNeFICIary DesIgNatIoN VaLID?

■ The designation on this form is valid until you redesignate a beneficiary on the Not Vested – Change of Beneficiary form; OR ■ You become vested (at which time your designation on this form may become inoperative) – you will need to submit a Vested – Change of Beneficiary form

at that time to designate a beneficiary, OR ■ You apply for retirement, at which time you will need to submit a Selection of Service Retirement Plan form to designate a beneficiary. ■ If you have more than one non-retired account with TMRS as a result of employment with more than one city, the beneficiary designation on this form will

apply to all cities.

DesIgNatINg yoUr beNeFICIary ■ You may designate up to three beneficiaries. Unless directed otherwise in writing on the form, your benefits will be paid equally to the surviving

beneficiaries. Please contact TMRS for instructions on how to provide for unequal distribution. ■ If you wish to designate alternate beneficiaries, please contact TMRS or your employing city – you will need to complete the Not Vested – Change of

Beneficiary form. Your benefits will be paid to your alternate beneficiaries only if the designation with respect to each primary beneficiary is revoked by death or your relationship with each primary beneficiary has terminated.

sUPPLeMeNtaL Death beNeFIts (sDb) ■ If your employer provides Supplemental Death Benefits (SDB) and you die while employed, TMRS will pay a one-time lump sum payment approximately equal

to one year’s salary based on the 12 months immediately preceding your month of death. ■ The SDB payment will be paid to the beneficiary(ies) designated on this form, even if you have previously designated a different SDB beneficiary. ■ If you wish to designate a different beneficiary(ies) other than the person(s) designated on this form to receive the SDB payment, you will need to

complete the Supplemental Death Benefit Beneficiary Designation form.

estate, trUst, aND CharIty DesIgNatIoNs ■ If you wish to designate your estate as beneficiary, please write only the word “ESTATE” in the space provided for the name of the beneficiary. ■ If you wish to designate a charity as beneficiary, please write the name of the charity (i.e., American Heart Association) in the space provided for the name of

the beneficiary. ■ If you wish to designate a trust, please write “Trustee of the (enter name of trust here)” in the space provided for the name of the beneficiary. Please ensure

that you have a legal trust agreement in place prior to designating a “Trust” on this form.

■ TMRS will accept the designation of a Trust. However, we cannot assure that if and when a benefit becomes payable from this System, the designation will be legally valid. In other words, if the trustee does not accept or has died, or if the trust has been revoked, or if for any other reason the designation is not legally sufficient at the time of the member’s death, the benefit due from the System will be paid in accordance with the provisions of the TMRS Act as if no trust/trustee had been designated.

DesIgNatINg MINor ChILDreN

Chapter 141 of the Texas Property Code is the Texas Uniform Transfers to Minors Act (TUTMA), which allows you to nominate a “custodian” to receive TMRS benefits on behalf of your minor beneficiary. If you wish to designate a minor child, please do the following:

■ Write the full name and all information pertaining to the minor child in the Beneficiary section of the form. Then complete the “Custodian Section” directly under the beneficiary section.

rULes ■ Only adults at least 21 years of age, financial institutions, corporations, or other legal entities may serve as custodians. ■ You cannot nominate two or more custodians to serve jointly. However, you may nominate a substitute custodian to serve in the event the first nominated cus-

todian dies before the first payment is made, declines, or is ineligible to serve. Please contact TMRS for instructions on how to nominate a substitute custodian. ■ You may designate the same custodian for up to three minors. If one custodian is named for all three minors, that custodian would receive separate benefit

payments for each minor. ■ When the minor beneficiary reaches age 21, the custodianship for that beneficiary as to TMRS benefits is terminated and any benefits that become payable will

be paid directly to that beneficiary. ■ The designated custodian may select any benefit option that the minor could select if the minor were an adult. ■ If an eligible custodian is designated to receive benefits, there is no limit on the amount of benefits that can be paid to the custodian. ■ The minor’s Social Security number is used for IRS reporting purposes.

tMrs WILL Not aCCePt ■ Attachments (listing additional beneficiaries – contact TMRS for the correct form to designate alternate beneficiaries) ■ Alterations without initials ■ An incomplete form or any attempt to change its provisions ■ An unacceptable beneficiary designation TMRS_0016

Social Security Administration

Statement Concerning Your Employment in a Job Not Covered by Social Security

Employee Name Employee ID#

Employer Name Employer ID#

Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected.

Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2013, the maximum monthly reduction in your Social Security benefit as a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, “Windfall Elimination Provision.”

Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension.

For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, “Government Pension Offset.”

For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office.

I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security Benefits.

Signature of Employee Date

Form SSA-1945 (01-2013) Destroy Prior Editions

City of Arlington 75-6000450

Information about Social Security Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

New legislation [Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004] requires State and local government employers to provide a statement to employees hired January 1, 2005 or later in a job not covered under Social Security. The statement explains how a pension from that job could affect future Social Security benefits to which they may become entitled.

Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is the document that employers should use to meet the requirements of the law. The SSA-1945 explains the potential effects of two provisions in the Social Security law for workers who also receive a pension based on their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a worker’s Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a Social Security benefit received as a spouse, surviving spouse, or an ex-spouse.

Employers must:

• Give the statement to the employee prior to the start of employment; • Get the employee’s signature on the form; and • Submit a copy of the signed form to the pension paying agency.

Social Security will not be setting any additional guidelines for the use of this form.

Copies of the SSA-1945 are available online at the Social Security website, www.socialsecurity.gov/online/ssa-1945.pdf. Paper copies can be requested by email at ofsm.oswm.rqct.orders@ssa.gov or by fax at 410-965-2037. The request must include the name, complete address and telephone number of the employer. Forms will not be sent to a post office box. Also, if appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in packages of 25. Please refer to Inventory Control Number (ICN) 276950 when ordering.

Form SSA-1945 (01-2013)

06/21-TA

City of Arlington

Notice of Personnel Manual

I hereby acknowledge that the Personnel Manual containing the City’s policies is available

to me electronically through the City of Arlington Employee Intranet located on the Human

Resources Portal. I understand it is my responsibility to review the manual within my first

thirty (30) days of employment. I agree to abide by all policies and provisions of the

Manual as a condition of employment. If I have any questions about a policy, I shall contact

my supervisor or my Consultant in the Human Resources Department.

Employee Name – Printed

Employee Signature

Date

06/21-TA

City of Arlington

Wage Deduction Authorization

While employed by the City of Arlington, I may be given certain clothing, equipment, or

other city property to use when performing my job. I understand that I am required to turn

in this clothing, equipment and other city property at the end of my employment. If I do not

turn in the above, or if the property is damaged or destroyed, I agree that the replacement

value or cost of repair of the clothing, equipment, or other city property shall be deducted

from my final paycheck. I hereby authorize the City of Arlington to deduct the replacement

cost or cost of repair of clothing, equipment, or other city property not returned at the end

of my employment, from my final paycheck.

Employee Name – Printed

Employee Signature

Date

Employee ID#

Temporary Beneficiary Designation Form (Full-Time Employees)

Complete this form to serve as your named beneficiary until you have the opportunity to enter beneficiary information in your Lawson Employee Self Service Account. If more space is needed, use the back of this form for additional beneficiary designations.

SECTION I

Employee ID and Name (Printed): ________________________________________________________

SECTION II – Employer-Provided Benefits (BENEFICIARY DESIGNATION MANDATORY)

A. Basic Group Term Life Insurance - Employer-paid life insurance of two (2) times the employee’sannual base salary rounded to next highest $1,000 to a maximum of $300,000.

Beneficiary: __________________________ Relationship: _________________________

B. TMRS Supplemental Life Insurance & Retirement Plan – Visit the TMRS website at www.tmrs.comand complete the Beneficiary form (TMRS-BENE).

SECTION III – Employee-Elected Supplemental Benefit Plans

A. Employee Supplemental Life AD&D Insurance Available in increments of $10,000 (minimum$20,000) to a maximum benefit of the lesser of $500,000 or 8 times the employee’s annual base salary.

Beneficiary: __________________________ Relationship: _________________________

B. Allstate Group Accident Plan – Death benefits payable based on plan enrollment.

Beneficiary: __________________________ Relationship: _________________________

C. Allstate Critical Illness Plan – Death benefits payable based on plan enrollment.

Beneficiary: __________________________ Relationship: _________________________

D. ICMA-RC 401k (Voluntary retirement plan. Employee may contribute up to IRS Maximum, the Citymatches 50% of employee’s contribution up to 6%). Beneficiary designations should be completed and/or updated at www.icmarc.org/arlington-tx or call 1-800-669-7400.

E. Deferred Compensation Plan (Voluntary 457(b) retirement plan which allows employees to deferadditional monies, coordinated with other tax-deferred contributions, to be set aside for retirement.)Beneficiary designations may be completed at www.icmarc.org/arlington-tx or call 1-800-669-7400.

SECTION IV – Signature

Employee Signature: ____________________________________ Date: ____________________

Reviewed 9/19 AVM

06/2021

City of Arlington New Employee Processing Guide

Name _____________________________ Hire Date _____________

Department _______________________ Position ______________

Comments

I-9 Form/Documentation ____ _____________________

W-4 Withholding Form ____ _____________________

Direct Deposit Form ____ _____________________

Terminal Pay Beneficiary Form ____ _____________________

EEO Supplemental Information ____ _____________________

AT- Will Employment ____ _____________________

Open Records/Personal Information ____ _____________________

Pay Periods ____ _____________________

TMRS Retirement System ____ _____________________

Social Security Statement ____ _____________________

Notice of Personnel Manual ____ _____________________

Wage Deduction Authorization ____ _____________________

_____________________________________ Employee Name – Printed – EID #

_____________________________________ Employee Signature

_____________________________________ Date

Departmental Supervisor on First Day of Employment

Comments

Department Organization _____ _____________________

Departmental Ethics Standards _____ _____________________

Working Hours/Days/Shifts _____ _____________________

Overtime _____ _____________________

Lunch Period _____ _____________________

Calling In Late or Absent _____ _____________________

Probationary Period _____ _____________________

Salary/Step Increases _____ _____________________

Performance Evaluations _____ _____________________

Merit Eligibility _____ _____________________

Policies – Departmental _____ _____________________

Grievance/Discipline Procedures _____ _____________________

Personal Phone Calls/E-Mails _____ _____________________

Safety Rules _____ _____________________

City Property – i.e. keys, uniforms _____ _____________________

Kronos/Reporting Time ____ _____________________

Cash Handling Training* ____ _____________________

(*If this position involves handling cash (cash, checks or credit cards) notify

Financial Services for Cash Handling training.)

The above information has been presented and explained to me and I understand it.

_____________________________________ Employee Signature – EID #

_____________________________________ Supervisor Signature

_____________________________________ Date

Return this form to Human Resources upon completion to MS 63-0790

06/2021