Download new hire check list - Southern Medical Corporation

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Transcript 
12133 Industriplex Blvd.
Baton Rouge, LA 70809
www.southernmedical.com
NEW HIRE CHECK LIST
Employee Name:
Employee #:
Department #:
Position:
Manager:
P/T:
Application
I-9 Form – Employment Eligibility
Driver’s License or State Issued ID (copy)
Social Security Verification (copy)
Drug Screen Confirmation
L-4 Form – State Witholding
W-4 Form – Federal Witholding
Credit / Background Check Authorization
Paycheck Protocol
Direct Deposit Authorization & Voided Check
Confidentiality Statement
Employee Handbook Acknowledgement
Hepatitis B
TB Skin Test
Christmas Club Authorization (FULL TIME ONLY)
Blue Cross Blue Shield Packet (FULL TIME ONLY)
AlwaysCare Form (FULL TIME ONLY)
Fidelity Info (FULL TIME ONLY)
Colonial Insurance Info (FULL TIME ONLY)
Assurant Form (FULL TIME ONLY)
Vehicle Responsibility Statement (DRIVERS ONLY)
Incident Report Verification (RT, RN, LPN ONLY)
Credentials (RT, RN, LPN ONLY)
Admin Initials (completed):



 Copies of front and back
 Copies of front and back










 $







 Copies of front and back
F/T:

PRN:

Pay Rate
Date of Hire
Faxed to LA New Hire Reporting
Report printed
Date vaccinated
Date of most recent test
Enrolled or Waived
Enrolled or Waived
Activated Online
Activated online
Date:
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