FLORIDAA & MUNIVERSITY

NEW EMPLOYEE SIGN-UP CHECKLIST

Faculty A & P USPS

Employee’s Name:
Position Title: / Position #:
Office Location: / Work #:

INSTRUCTIONS:

  1. Check the appropriate blocks to indicate the forms that are included in the new employment packet.
  2. Review each section carefully and complete the appropriate forms
  3. Submit the completed forms to the Office of Human Resources

Collection of Employee’s Social Security Number Form(signed and dated)

Personal Information Form (signed and dated)

Oath of Loyalty (notarized)

Authorization for Fingerprinting

W-4 Card (signed and dated)

I-9 Form with the appropriate documentation according to instructions.

Social Security Card (Copy)

Photo Identification Card (Copy)

Direct Deposit Authorization Form(Mandatory)

This is to certify that I have completed all of the required forms that are necessary to add my name to the University’s Payroll pursuant to this checklist.

Employee Signature:______Date:______

Paperwork for insurance selection must be completed within 60 days from the date you begin employment. Employees not completing the appropriate insurance paperwork will not be eligible to elect coverage until open enrollment.

Acknowledgement Insurance/Pre-Tax Benefits/ORP Retirement Options

Benefits Package

  • Summary of Benefits
  • Employee Group Insurance Package
  • Sick Leave Pool Highlights and Application for Sick Leave Pool
  • Family & Medical Leave Act 1993
  • Retirement Plan Alternatives and FRS Guide
  • Insurance Brochures

FloridaA&MUniversity

Office of Human Resources

Collection of Employees’ Social Security Numbers

In compliance with the provisions of Section 119.071(5), Florida Statutes, the Florida Agricultural and Mechanical University, Office of Human Resources collects an individual employee’s social security number for legitimate business purposes, as specifically authorized by law and in the performance of the duties and responsibilities for the following reasons:

  • Completing and processing the Federal I-9 (Department of Homeland Security)
  • Completing and processing Federal W4, W2, 1099 (Internal Revenue Service)
  • Completing and processing Federal Social Security taxes (FICA)
  • Processing and Distributing Federal W2 (Internal Revenue Service)
  • Completing and processing quarterly Unemployment Reports (Florida Department of Revenue)
  • Completing and processing Florida Retirement Contribution reports (Florida Department of Revenue)
  • Workers’ Comp Claims (FCCRMC and Department of Labor)
  • Completing and processing Direct Deposit Files (ACH)
  • Completing and processing 403b and 457b contribution reports
  • Completing and processing group health, life and dental coverage enrollment
  • Completing and processing various supplemental insurance deduction reports

The social security numbers collected by the Office of Human Resources will not be used for any purpose other than the purposes stated above.

I understand the above information and have been given a copy of this document.

______

Employee Signature Date

OATH OF LOYALTY

STATE OF FLORIDA

COUNTY OF ______

“I, ______, a citizen of ______and being employed by or an officer of the State of Florida and a recipient of public funds as such employee or officer, do hereby swear or affirm that I will support the Constitution of the United States of America and of the State of Florida.”

______

Signature

FOR NOTARY USE ONLY (Please do not write below this line)

Sworn to and subscribed before me this _____ day of ______, 20___.

______

OPS STAFF OPS STUDENT ADJUNCT/FACULTY
USPS A&P GRADUATE ASSISTANT

Notary Signature