YMCA of Greater New Orleans - Personnel Process Form Data to be completed by employee Employee Name:________________________________________ S.S.#:_______/______/__________ First M.I. Last Branch:_______________________________________ Position:______________________________
Data to be completed by new employees/employees changing telephone # or address Address:__________________________________________________________________________________________ Street Apt.# City State Zip Code Telephone#:________________________________ Date of Birth:_____/_____/_________ Sex (circle one): M or F Cell#:___________________________________
E-mail:_______________________________________
Race: ____ Asian ____ American Indian ____ Black ____ Native Hawaiian/Pacific Islander ____ White ____ Other Ethnicity: ____ Hispanic/Latino ____ Not Hispanic/Latino Previous YMCA Experience:
_____ Yes
_____ No
If yes, please indicate when and where:_________________________________________________________________
Reason for Change (to be completed by director/supervisor) □ New Hire/Rehire/Promotion – Eff. Date:____________________ Position:__________________________________ Pay Grade:______ Dept. Code:__________________________ Starting Wage/Salary:________________________ Status:
______ Full-time ______ Part-time
Schedule:
______ Regular
______ Temporary (seasonal)
□ Add Coding/Rate: Dept. Code:__________________________ Rate:_____________________ □ Change of Address/Telephone # (as indicated above)
□ New Direct Deposit (attach direct deposit form)
□ Change in Withholdings (attach W-4 and/or L-4) □ Pay Increase Type:_________________ Eff. Date:_______________ New Pay Rate:___________________________ □ Other (please specify):______________________________________________ Comments, if necessary:_____________________________________________________________________________
Required Signatures: Employee:_______________________ Date:_________ Supervisor:__________________________ Date:__________ Branch Exec:____________________ Date:__________ HR Director:________________________ Date:__________ President/CEO:______________________________________ Entered Payroll:________________________________ Personnel Process Form - Updated 12/22/2011