New Employee Information Form

"*" indicates required fields

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Employer Information

Employer Name*

Location/Store #

Employee Information

Employee Legal Name*

First Last

Hire Date*

Email*

Cell Phone Number*

Birthdate*

Job Title/Department

Job Category

Pay Rate*

Type*

Status*

Bank Information*

Money Network Account No*

Employers or an authorized representative must complete and sign this section. You must physically examine the documents.

List A

U. S. Passport
U. S. Passport Card
Other

List B

Driver’s License Issued by State
ID Card Issued by State
School ID Card
Other

List C

Social Security Card
Birth Certificate

Document Type*

Provide 1 Document from List A

Provide 1 Document from List B & 1 Document from List C

List A

Document*

Document Number*

Expiration Date*

Month

Day

Year

Other*

Upload Document

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.

List B

Document*

Other

Upload Document

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.

Issuing Authority*

Name of School*

Document Number*

Expiration Date Options

This document has no expiration date.

Expiration Date*

List C

Document*

Issuing Authority*

Document Number*

Document Verification

Manager's Signature*

Manager's Name*

First Last

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