Fairfield County
New Employee Payroll Forms Checklist
Fairfield County
New Employee Payroll Forms Checklist
Employee:
Hire Date:
Department:
Department Representative: Phone:
Submit To: County Auditor’s Finance Office (Payroll Section)
Required Forms For Adding New Employee To County Payroll
Please see the attached detailed instructions for completing the individual forms.
Form /Form Required? / Submitted
(Yes/No) / Date
Submitted
Fairfield County
Employment Information / Yes
Personal History Record (Form A) (PERS)
or
New Hire Notification Form (STRS) / Yes
Yes
Notice of Re-Employment of a
PERS Retiree (Form SR-6)
(PERS) / Is this employee receiving retirement or disability benefits from PERS?
Yes ______No ______
If so, this form must be completed and submitted.
Employment Eligibility Verification
(U.S. Department of Justice) /
Yes
/ /Form W-4 (Internal Revenue Service) / Yes
Form SSA-1945 (Social Security) / Yes
Employee Withholding Exemption Certificate (State of Ohio) / Yes
Schedule C (Fairfield County) / If employee is authorized to drive a county vehicle.
Authorization Agreement
for Direct Deposit / If employee wants direct deposit of payroll check.
Department Representative:
Please submit all required forms (including this form) within three days of hire, properly completed and signed by the employee, along with this checklist, to the Auditor Finance Office. If any forms are missing or incomplete, the entire package will be returned to the department for completion. This may result in the following; postponement of pay and/or ineligibility for insurance benefits.
I have verified that all required forms are complete and are included with this New Employee packet.
Department verification signature:______Date: ______
Detailed Form Instructions
Fairfield County Employment Information
§ Employee must complete the General Information section.
§ Completion of the Civil Service Information section is optional.
§ Employee must answer the first question in the Previous Employment Information section. If the answer to question 1 is “yes,” then the remaining questions in this section must be answered.
Personal History Record from PERS (Form A)
§ Form must be completed in duplicate (both copies must have original signatures).
§ Section I – Personal Information. Must be completed
§ Section II – Service Information. Must be completed. Ensure that questions 1, 2, and 3 are fully answered.
§ Section III – Beneficiary Designation. Ensure that employee reads and understands this.
§ Section IV – Employee Certification. Employee must sign.
§ Section V – Payroll Officer’s Certification. Must be completed.
STRS New Hire Notification (State Teachers Retirement System of Ohio)
§ Employee must complete the Employee Information section
Notice of Re-Employment of a PERS Retiree (Form SR-6)
Form must be completed if employee is receiving retirement or disability benefits from PERS. This form must be completed and submitted to PERS by the end of the first month of employment. Failure to do so will result in employer liability for overpaid benefits.
If the retiree is re-employed within the last ten days of a month, notify the Finance Office immediately to prevent an overpayment of pension; confirmation must then be made on Form SR-6 within ten days.
§ Section 1. Department must complete with information supplied by employee.
§ Section 2. Department must complete.
§ Section 3. Employee must sign.
§ Section 4. Department’s fiscal officer must complete and sign.
Employment Eligibility Verification from U.S. Department of Justice
Please read all instructions before completing the form.
§ Section 1. Employee must complete and sign.
§ Section 2. Payroll officer is required to examine copies of acceptable documents listed on back of form and complete the section.
§ Section 3. Do not complete.
Form W-4 from Internal Revenue Service
§ Employee must complete sections 1, 2, 3, and 5.
§ If employee wants additional taxes withheld, then section 6 must be completed.
§ If employee claims exemption for all withholding for the year (meeting both listed conditions), then section 7 must be completed. Enter the word “Exempt.”
§ Employee can change this form at any time, when there is a change in his/her tax status.
Form SSA-1945 from Social Security Administration
§ Employee must complete, sign and date form.
Employee’s Withholding Exemption Certificate — State of Ohio Taxation Department
§ Employee must complete name, social security number, address, public school district of residence, and school district number.
§ Employee must enter allowable exemptions in lines 1, 2, 3, and 4.
§ If employee wants additional taxes withheld, then line 5 must be completed.
§ Employee must sign and date form.
Schedule C
This form is required for insurance purposes. It must be completed if the employee will drive a county vehicle or his/her personal vehicle on County business.
Authorization Agreement for Direct Deposit (ACH Credits)
§ Section 1: Banking Information. Employee must complete all parts. Employee may wish to contact bank for assistance in completing this section.
§ Section 2: Authorization. Employee must print name, enter social security number, sign, and date the form.
§ Sections 3 and 4 will be completed by the County Auditor’s Office.
Revised 4-30-2001 Exhibit F-1
Fairfield County
New Employee Payroll Forms Checklist
Revised 4-30-2001 Exhibit F-1