Laserfiche WebLink
Congratulations! You are Employed ! <br />Now what? Please work with your job coach to complete the form below <br />Employee's Name:Employer's Name: <br />Employee's Job Title:Employer's Address: <br />ls this a new iob? f ruo <br />Date Employee Started Work <br />Yes <br />Average Number of Hours Worked Per Week: <br />Rate of Pay or Salary: $ <br />Hourly! Monthly! Annually <br />Pay Frequency: <br />Daily ! Weekly ! fvery Two Weeks ! fwo Times a Month f vtonthly I <br />Overtime: I ruo X <br />Yes; if yes, how often and how much? <br />Yes; if yes, how often and how much? <br />Yes; if yes, how often and how much? <br />Yes; if yes, how often and how much? <br />Work Schedule (include exact times when possible): <br />Monday Tuesday Wednesday Thursday Friday Saturday <br />Tips: <br />Commissions: <br />Bonuses: <br />No <br />No <br />No <br />ls health insurance available: E ruo ! ves <br />L. lf yes, did the employee enroll in the health plan? I ttto <br />a. lf yes, when does the coverage begin? <br />b. lf yes, what is the employee's portion of the premiums? $ <br />Name and Title of Person Who Completed This Page: Date: <br />Yes <br />Sunday <br />DVRSch oo lToWo rk @ dsh s.wa. eov Page 22