New Hire, Form 2

Form to collect new hire information and documents.

Preferred First and Last Name
The staff will know you by these two names. The names will also be used to build your email address and access badge.
Type in your work email address, if this has been issued.
State ID/DL Names
Your names as they appear on your state ID/Driver's License
Enter your Driver's License Number.
Enter the your Driver's License Expiration Date.
MM slash DD slash YYYY
Enter the expiration date of your current Car Insurance.
MM slash DD slash YYYY
Enter the date that you initiated your Motor Vehicles Record check.
MM slash DD slash YYYY

Vaccination and Medical Info

Please select your Covid vaccination status. Partially Vaccinated: One dose completed for a two dose series. Fully Vaccinated: Received both doses or completed a single dose vaccination. Exempt: Medically exempt from vaccination requirement.
Input the date of your most recent Covid vaccination.
MM slash DD slash YYYY
Input the date that you received the results of your most recent TB Test.
MM slash DD slash YYYY
Enter the date which you submitted your Immunization Records.
MM slash DD slash YYYY

Certifications and Clearances

Enter the date in which your CPR certification will expire.
MM slash DD slash YYYY
Enter the date in which your First Aid certification will expire.
MM slash DD slash YYYY
MM slash DD slash YYYY
Input your Fingerprint Clearance Card Number.
Enter the date which your Fingerprint Clearance Card will expire.
MM slash DD slash YYYY
Max. file size: 256 MB.