Employee On-boarding Form Required Information* New Hire RE-Hire Department Transfer Employment Status Per Diem ( CM / WC ) Full Time Regular Part - Time (25 hours per week) Irregular Part - Time (Variable hours) Employee Name* First Last Start Date* MM slash DD slash YYYY Orientation Date* MM slash DD slash YYYY Position* Is this an Office Role? Yes No If yes, where will they be seated (please indicate phase and location of desk) Is this a client facing role? Yes No If you have select CM or WC please define the populations they will serve Select All Child Adult Please list credentials that should be attached to their signature in EHR (If applicable) Manager/Supervisor* Manager/Supervisor Email* What Systems do they need access to?* Email/Secure Email Add to HAMWORKERBEE Directory Sharepoint - Employee Intranet KePro EIS WITS ZenDesk Hamworkerbees email Ability to scan from printers Spreadsheet Access on H Drive EHRYW ZIX Portal Additional E-mail Distribution Groups Needed Specific document libraries needed on sharepoint (alternatively known as access level) within specific department EHR Access - Please indicate a current or previous user that you would like the new users access to be copied from. Spreadsheet access on H DriveIf employee needs access to restricted spreadsheets on the H Drive, please list here.Hardware* Work Cellphone Verizon Hotspot (if both verizon and US cellular are needed specific approval from Operations Director is required) U.S. Cellular Hotspot (if both verizon and US cellular are needed specific approval from Operations Director is required) RCA/Chromebook Desktop Computer Desktop Phone Phone Headset Computer/desktop headset Desktop Printer Desktop Scanner Webcam Human Resources Written offer letter Case Manager Orientation Case manager directory in sharepoint Background Checks Ergonomic check with CMCC Benefits meeting (Full time employees only) ADP Access Time Clock Office Key/Access Pass ID Badge Business Cards Back Office Access MIHMS VMS Portal Cubical Name Tags OtherIf anything not listed is needed, please describe here.For Internal Transfers Only - Please list any previous e-mail groups, lists, folders, sharepoint groups/access, systems, hardware, software, etc. from their previous position that will no longer be needed.If anything not listed is needed, please describe here.