NEW EMPLOYEE REQUEST FORM

Fields marked with a * are required.

    Director Contact Information

    Director – Name*

    Director – Email Address*

    Director – Phone Number*

    Employee information

    First Name*

    Last Name*

    Employee’s personal E-Mail address*

    Date of Birth*

    Gender*

    Ethnicity*

    Address*

    City*

    State*

    Zip*

    Home Phone

    Cell Phone

    Position Information

    Job Title*

    Facility (Check primary site)*

    Department*

    Date of Hire(Accepted Offer)*

    Date to issue Account(s)/Equipment/IT Orientation*

    Date to start Training*

    Date to start working with Clients*

    Ending Date (if any)

    Employment Type

    Supervisor (if not a director)

    Employee will need access to KIPU.

    Employee has credentials (to be verified by HR).

    Employee will need a drug screen.

    Employee will need a TB test.

    Employee is new to MARR and needs to complete new hire orientation.

    Notes (work phone number, replacing former employee, other information)

    NOTE: Filling out this form will begin the process of a background check, drug screen, account generation, and access to Hatch. The employee MUST have cleared a background check, drug screen, and have completed MARR orientation before they can begin working with clients. EMPLOYEES CANNOT BEGIN EMPLOYMENT UNTIL THESE ARE COMPLETED. Contact Brenda Bray in HR at 678-805-5108 for any questions on the background check and drug screen.

    *Your request will be processed within 1 business day.

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