North East Independent School District

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1 North East Independent School District 8961 TESORO DRIVE SAN ANTONIO, TEXAS Phone (210) , Fax (210) OFFICE OF THE EXECUTIVE DIRECTOR OF HUMAN RESOURCES INSTRUCTIONS FOR COMPLETING HUMAN RESOURCES CERTIFIED NEW HIRE PAPERWORK ACKNOWLEDGEMENT FORM Please complete, sign and return this form including all requested documents listed below (Items #28 through #35) to New Employee Orientation. 28) 29) TEA TEXAS PUBLIC SCHOOL STUDENT/STAFF ETHNICITY AND RACE DATA QUESTIONNAIRE Complete the top portion with your name and the last four digits of your social security number You must answer Part 1 and Part 2 Sign and date the form EMPLOYEE DIRECTORY RESTRICTION INFORMATION Complete the top portion with your name and your social security number Select I want to RESTRICT access OR I DO NOT want to restrict Sign and date the form INSTRUCTIONS FOR COMPLETING PAYROLL NEW HIRE PAPERWORK 30) 31) DIRECT DEPOSIT OF PAYROLL CHECK North East I.S.D. requires mandatory direct deposit for all employees. You must complete the North East ISD Authorization Agreement for Direct Deposit Please complete this form by filling in ALL appropriate information and attaching a VOIDED CHECK or a printed form that your bank can produce specifically for direct deposit. Please do not attach a deposit slip as some banks do not have the same routing # on checks and deposit slips. ADP Pay Card Enrollment Form (MUST COMPLETE IF YOU DON T HAVE A BANK ACCOUNT AT ALL) OR, if you do not have your bank account information by orientation, you MUST complete the ADP Pay Card Enrollment form. You will be automatically enrolled for your pay checks. If you need to change to your bank information later, you can make the changes on the Employee Portal. 32) W - 4 FORM Complete items 1-7, sign and date. DO NOT SEPARATE FORM. You must use your legal name (as it appears on your social security card) on all your tax forms. BOX 5 must have a number entered. "0" means you want the MOST taxes taken out of your paycheck. YOU will need to consult someone (parent, spouse, friend, accountant) if you are unsure. Please make sure to sign and date this form. 33) 34) 35) TEACHER RETIREMENT ELIGIBILITY INFORMATION Every New Hire must complete this form in its entirety. Read and answer questions. DESIGNATION OF BENEFICIARY This is the person who we can release your last pay check to if any wages are owed to you at time of death while employed at NEISD. Please complete all areas of this form. SOCIAL SECURITY FORM SSA Print name, ID # (this is your social security #), read, sign, and date. Due to the participation in our qualified retirement plan, TRS, we do not take the Social Security portion of FICA from your check. Please contact the SS Office for any questions. An Equal Opportunity Employer

2 North East Independent School District 8961 TESORO 8961 TESORO DRIVE SAN ANTONIO, TEXAS TEXAS Phone Phone (210) (210) , Fax (210) (210) OFFICE OF THE EXECUTIVE DIRECTOR OF HUMAN RESOURCES ACKNOWLEDGEMENT FORM Certified (Professional/Teacher) New Hires Please complete, sign and return this form and all requested documents (Items #28 through #35) to New Employee Orientation. Employee Full Legal Name Last 4 Digits of Social Security # (As it is on social security card) I acknowledge that I have received, read and/or viewed the video clips within the information listed below (Items #1 through #27). NOTE: Employees are responsible for maintaining copies of these documents for their personal records and any updates which may occur. 1. Benefits: Continuation of Health Coverage 2. Benefits: Exchange Notification 3. Benefits: Health Insurance Portability and Accountability Act Notice of Privacy Practices 4. Benefits: Important Notice of your Right To Documentation of Health Coverage 5. Board Policy: Term Contracts: Nonrenewal DFBB (LOCAL) 6. Board Policy: Assignment and Schedules DK (LOCAL) 7. Board Policy: Standards of Conduct DH (LOCAL)AND DH (EXHIBIT) 8. Board Policy: Compensation and Benefits: Leaves and Absences DEC (LOCAL) 9. Board Policy: Compensation and Benefits: Salaries, Wages, and Stipends DEA (LOCAL) 10. Board Policy: Drug Free Workplace Notice DI (EXHIBIT) 11. Board Policy: Employee Welfare: Freedom from Discrimination, Harassment, and Retaliation DIA (LOCAL) 12. Board Policy: Personnel-Management Relations: Employee Complaints/Grievances DGBA (LOCAL) 13. Board Policy: Relations with Governmental Entities: State and Local Governmental Authorities GRA (LOCAL) 14. Board Policy: Student Discipline FO (LOCAL) 15. Board Policy: Student Welfare: Child Abuse and Neglect FFG (EXHIBIT) 16. Board Policy: Student Welfare: Freedom from Bullying FFI (LOCAL) 17. Health Services: Sexual Abuse and Maltreatment Video 18. Human Resources: Confidentiality Agreement 19. Human Resources: Employee Dress Code 20. Human Resources: Policies and Procedures 21. Human Resources: Proration of Salary 22. Human Resources: Smart Find Express Presentation 23. Safety: General Safety Rules 24. Safety: Worker s Compensation 25. Safety: HAZCOM Training Information and Video 26. Safety: Safe and Drug Free Workplace Letter 27. Technology Services: Acceptable Use of District Electronic Communications System Complete and return Items #28 through #35 to the Human Resources Department along with this form. Item Form Title 28. TEA Texas Public School Student/Staff Ethnicity and Race Data Questionnaire 29. Employee Directory Restriction Information 30. Direct Deposit 31. ADP Pay Card Enrollment Form 32. W-4 Form 33. Teacher Retirement Eligibility Information 34. Designation of Beneficiary 35. Social Security Form SSA-1945 Office Use Only Employee Signature Date An Equal Opportunity Employer

3 Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire Employee Name (Please Print): Last 4 of SSN#: The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student s or staff member s ethnicity and race. United States Federal Register (71 FR 44866) Part I: Ethnicity Is the person Hispanic/Latino (Choose Only One) Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Not Hispanic/Latino Part II: Race What is the person s race (Choose One or More) American Indian - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Employee Signature Date Revised 10/23/13 goj

4 NORTH EAST INDEPENDENT SCHOOL DISTRICT EMPLOYEE DIRECTORY INFORMATION RESTRICTION Employee directory information is available to the general public within the regulations of the Texas Open Records Act. Directory information, as defined by the Open Records Act, includes name, home address and phone number, sex, ethnicity, salary, title (position or grade/subject taught) and dates of employment. By law, all employees must be given the opportunity to restrict public access to their home address and phone number. Please complete the form below advising North East of your wishes with regard to public access to your directory information. It is important that all items on this form be fully completed in order to process your request. I want to restrict public access to my address and phone number. I do not want to restrict public access to my address and phone number. Employee Name: Last 4 Digits of Social Security #: Home Address: Phone: Street City State Zip Code Position / Grade or Subject Taught: Campus / Department: I understand that if I restrict access to my address and telephone number, only my name and position will appear in the district s employee directory. I also understand that my address and phone number will not be made available for public access. Employee Signature: Date: Restriction Received School/Department Official: Date: HR Official: Date: Once the campus or department makes a note of your restriction, the form will remain on file in the HR Department, 8961 Tesoro Drive Suite 200 San Antonio, TX Should you wish at any time during your employment with NEISD to open or close access to your home address and phone number please go to the HR Department s Intranet page / Forms to obtain and complete another copy of the Employee Directory Information Restriction form. Send the corrected form completely filled in to the HR Department. Monthly Employees Send your form to HR attention: Valerie Wentworth Biweekly Employees Send your form to HR attention: Mary Preston Revised 8/26/13

5 NORTH EAST INDEPENDENT SCHOOL DISTRICT DIRECT DEPOSIT OF PAYROLL CHECK NAME: Last First MI Certified Paraprofessional Auxiliary (CERTIFIED: Teachers, Administrators) (Para: Assistants or Instructional Support) (Aux: Trans, Food Service, Maintenance, KIN, Police) Campus/Dept Social Security: Eligibility Requirements and General Information Direct deposit of payroll checks is mandatory for certified, classified, and substitute employees. The effective date for initial direct deposit will be determined by the date the authorization is received in the Payroll Office. If you do not have your Direct Deposit Bank information, you must complete the ADP Pay Card Enrollment form. You will automatically be enrolled for the ADP Pay Card for your paychecks. After that, Direct Deposit changes must be completed using the NEISD Employee Portal. AUTHORIZATION OF PRIMARY DIRECT DEPOSIT I hereby authorize the NEISD Payroll Office to deposit my NET Pay in the following institution: Bank Name: Routing # (Please fill in information) Type of Account: Checking Savings Account # (Please fill in information) SECONDARY DIRECT DEPOSIT: Amount to be deposited per Pay Period: $ Bank Name: Routing # Type of Account: Checking Savings Account # Please attach (tape) a VOIDED check Or Attach Bank Print out to this form. Ex: Ex: st nine numbers on left are Routing # Account # SIGNATURE: DATE: NEO DD Form Revised 10/2013

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9 North East Independent School District 8961 TESORO DR., SUITE 201 SAN ANTONIO, TEXAS (210) Department of Payroll TEACHER RETIREMENT SYSTEM ELIGIBILITY INFORMATION **PLEASE NOTE THAT IF THIS IS YOUR FIRST TIME WORKING FOR A SCHOOL DISTRICT IN THE STATE OF TEXAS, THEN ALL YOUR ANSWERS WILL BE NO. **SUBSTITUTE EMPLOYEES DO NOT PAY INTO TRS. 1) HAVE YOU EVER BEEN A TEXAS TRS MEMBER? YES NO If you were employed with a Texas School District at any time prior to your hire date and paid into TRS, then your answer is YES. 2) IF YES, PLEASE PROVIDE DATE/YEAR YOU WERE LAST EMPLOYED WITH A TEXAS SCHOOL DISTRICT 3) HAVE YOU WITHDRAWN FROM YOUR TRS ACCOUNT? YES NO You would have completed a TRS 6 form: Application for Refund 4) ARE YOU A TEXAS TRS RETIREE? YES NO 5) IF YES, PLEASE PROVIDE RETIREMENT DATE EMPLOYEE SIGNATURE: PRINT NAME: EMPLOYEE SOCIAL SECURITY NUMBER: DATE: AN EQUAL OPPORTUNITY EMPLOYER

10 North East Independent School District 8961 TESORO DRIVE, SUITE 201 SAN ANTONIO, TEXAS Telephone: (210) Facsimile: (210) Department of Payroll Designation of Beneficiary (Wages or Salary) In the event that North East Independent School District (the District ) owes me any wages or salary at the time of my death, I hereby designate the following person as the beneficiary to whom any such wages or salary shall be paid after my death by the District, in accordance with Section 450 of the Texas Probate Code: Beneficiary s Name: Beneficiary s Address: Beneficiary s relation to me: If the beneficiary designated above is my current spouse; if I am divorced from such spouse at the time of my death; and if I have not changed by then the name of my beneficiary on the District s records, the District shall have the option of paying the above-described monies either to the beneficiary designated or to my estate. This instrument applies to wages or salary only, and does not affect any other payments which may be owing for example, insurance proceeds, death benefits, deferred compensation, retirement benefits, or any other. Employee Signature Date Employee Printed Name Employee SS# Number REVISED AUGUST 2013

11 Statement Concerning Your Employment in a Job Not Covered by Social Security Employee Name: Employee ID/SS# Employer Name: NORTH EAST ISD Employer id#: Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected. Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $ This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, Windfall Elimination Provision. Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension. For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, Government Pension Offset. For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at You may also call toll free , or for the deaf or hard of hearing call the TTY number , or contact your local Social Security office. I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security benefits. Signature of Employee Date Form SSA-1945 ( )

12 Information about Social Security Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security New legislation [Section 419(c) of Public Law , the Social Security Protection Act of 2004] requires State and local government employers to provide a statement to employees hired January 1, 2005 or later in a job not covered under Social Security. The statement explains how a pension from that job could affect future Social Security benefits to which they may become entitled. Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is the document that employers should use to meet the requirements of the law. The SSA-1945 explains the potential effects of two provisions in the Social Security law for workers who also receive a pension based on their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a worker s Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a Social Security benefit received as a spouse or an ex-spouse. Employers must: Give the statement to the employee prior to the start of employment; Get the employee s signature on the form; and Submit a copy of the signed form to the pension paying agency. Social Security will not be setting any additional guidelines for the use of this form. Copies of the SSA-1945 are available online at the Social Security website, Paper copies can be requested by at or by fax at The request must include the name, complete address and telephone number of the employer. Forms will not be sent to a post office box. Also, if appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in packages of 25. Please refer to Inventory Control Number (ICN) when ordering. Form SSA-1945 ( )

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