PAPERWORK MUST BE SUBMITTED TO THE JERICHO OFFICE ...

(D.P.F 4-H Camp Orientation) ALL PAPERWORK MUST BE SUBMITTED TO THE JERICHO OFFICE BY MAY 15, 2015   2015 CHECKLIST of

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ITEMS TO RETURN TO HR :

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__ Offer Letter & PD signed by you

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__ W4 __ Background check form

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__ Medical Form __ internet communication policy __ I-9 printed / top completed (check the list on the I-9 for acceptable documents)

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__ Voluntary disclosure form

Once on our Camp Staff Only page, please click onto “click here” for instructions and forms Please click “All other staff members” and print the following forms listed below, complete and sign. Please sign your offer letter attached to your welcome email W-4 form Background check authorization form Staff Medical form – you and your doctor must fully complete this form. Junior Counselors must also complete Physician Form as well as Staff Medical Form Direct Deposit Form (optional) this is required only if you choose to have your check direct deposited. Note: if this form is not submitted, your paycheck will be mailed to you at your address on file. Policy regarding internet communications The I-9 Employment Eligibility Verification form must be completed in person 2 weeks prior to the first day of your employment You may print pages 7-8 and bring them: DO NOT SIGN IT. Page 9 lists the acceptable documents for employment eligibility verification. You MUST bring ORIGINAL Documents. Photo Release Form Voluntary Disclosure form NYSERS waiver form along with form RS-6357. Note: if you are a member of the NY State retirement program or wish to become a member do not complete these forms, Please call 516-433-7970 ext 17 for more information. As a seasonal employee you have the option to become a member or opt out. 3% will be deducted from your salary every pay period if you elect to become a member. RS-6357 Must be notarized! IT-2104-E form. Note: Only complete this form if you meet the following qualifications in either Group A or Group B. Group A:

__ Photo Release form

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__Direct Deposit form (optional) __IT-2104-E __NYSER waiver of enrollment & RS-6357 survivor benefit programnonmember form (optional)

you must be under age 18, or over age 65, or a full‑time student under age 25; and you did not have a New York income tax liability for 2013; and you do not expect to have a New York income tax liability for 2014 (for this purpose, you have a tax liability if your return shows tax before the allowance of any credit for income tax withheld). Group B:

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FOR HR USE:

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__ Completed Application

you meet the conditions set forth under the Service members Civil Relief Act (SCRA), as amended by the Military Spouses Residency Relief Act. See Military spouses.

__ Completed Background Screen, date: __________

Please return all completed documents to me, no later than 05/15/2014 by mail to Cornell Cooperative Extension of Nassau County, 5 Old Jericho Tpke, Jericho, NY 11753.

__ Completed I-9

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__ Completed MV Check, date__________ __ Forwarded Paperwork to Payroll __ Retirement Completed 4/27/15

Your Orientation will take place at D.P.F 4-H Camp. If you cannot make your assigned orientation, please call me to discuss further. It is important that new hire/rehire orientation is completed on or BEFORE your scheduled start date.

Welcome aboard and I look forward to working with you. Feel free to call me with any questions that you might have before you start. I can be reached at 516-433-7970 x17 or e-mail [email protected]. Dionne Marshak, Human Resources