New Hire Paperwork

New Hire Paperwork Instructions

Congratulations on your new position with Penn State Hershey Medical Center!  We are excited that you have decided to join our family of amazing employees. Prior to New Employee Orientation, you are required to complete new hire paperwork.  We have provided the forms here so that you can complete them prior to your scheduled orientation. To assist you with completing these forms, please click hereIf at any point you have questions or concerns, please do not hesitate to contact your HR Recruiter or our HR Solution Center at 717-531-8440.

PLEASE NOTE:

You must have Adobe Reader to use these forms. Adobe Reader is free software that lets users view, fill, and print filled in Adobe PDF files on all major computer platforms. Some of the forms are provided as "fillable" PDF files for your convenience. You must have at least Adobe Acrobat Reader 4.0 installed on your computer to view, complete, and print fillable forms. Get Adobe Reader here: http://get.adobe.com/reader/

Instructions for "Fillable" PDF files: Acrobat Reader does not allow you to save what you key into the form, nor can you email the completed form – you should plan on completing the form and immediately printing the completed form. It may be easier to print and complete all of the forms by hand. You may do what works best for you.

FORM 1: New Hire Checklist

Details: This is an overview of all the forms that follow below, including important points to remember and what documents you are required to bring to New Employee Orientation. Please pay close attention to this form as it will serve as a guide to assist you with the completion of your paperwork. 

FORM 2: Local Earned Income Tax Residency Certification Form

Details: This form is used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes. Please complete all highlighted fields; however, please leave the Employer FEIN and PSD Fields blank (our Payroll Department will provide this information).

FORM 3: W-4 Form

Details: This form allows us to withhold the correct federal income tax from your pay. Please complete the bottom half of this form.

FORM 4: Form I-9

Details:  All U.S. Employers must complete and retain a Form I-9 for each individual they hire for employment in the United States – Original documents are required – no photocopies. This includes citizens and non-citizens. On the form, the employer must examine the employment eligibility and identity document(s) an employee presents to determine whether the document(s) reasonably appear to be genuine and relate to the individual. Employers must also record the document information on the Form I-9. The list of acceptable forms of documentation are attached along with the form itself.

FORM 5: Direct Deposit Form

Details:  For your convenience, Penn State Hershey Medical Center allows employees to authorize automatic payroll and/or expense reimbursement to be deposited into their checking accounts at almost any bank or financial institution in the United States. Please be sure to complete all highlighted sections of this form. You may designate separate accounts for payroll and/or expense reimbursements. Instructions on how to have your paycheck directly deposited into your account are included on this form.

FORMS 6, 7 and 8: Self-Identification Forms:

Details: Penn State Hershey Medical Center is an equal opportunity/affirmative action employer. As a federal contractor, we are required to keep records on the race, sex, ethnicity, disability and veteran status of our employees and to file periodic reports with the government. This information will be kept confidential. Please complete all three forms.

FORM 9: Worker's Compensation Form

Details: If you are injured at work or suffer an occupational illness, you have certain legal rights and duties under Section 306 (f.1) (I)(i) of the Worker's Compensation Act regarding your medical treatment.  This document details those rights and duties.  You will need to certify that you have been informed and understand these rights and duties at the bottom of this form.

FORM 10: Intellectual Property Agreement (IPA) Form

Details: This form provides detailed information about the terms of the agreement.  You will need to print, sign and date this form.  An HR professional will provide the Witness signature. 

FORM 11: Employee Health Department - New Hire Requirements

Details: You will be scheduled for an Employee Health appointment within 10 days. Documentation of your vaccination record must be provided to Employee Health prior to your appointment. Details of what is required are outlined on this form.

FORM 12: Campus Map

Details:  We have included a copy of the Campus Map to assist you with finding your orientation location.

FORM 13: Parking Registration Form:  (Please click on this link to complete the online form.)

Details: All employees who are driving on campus must provide complete vehicle information for any vehicle you will be driving on campus. You will receive a vehicle permit sticker for each vehicle you register when you arrive for orientation. To be compliant with Penn State Hershey Medical Center Parking Policy, your Parking Registration card must be submitted the Wednesday prior to your New Employee Orientation date.

Parking Rules and RegulationsThis is an overview of Campus Driving, Parking Rules, Regulations and Information.

** Important: The following new hires will also need to complete an IT Account Request form:

  • Anesthesia Tech
  • Echo Peds Tech
  • ED Tech
  • EKG Tech
  • Endoscopy Tech
  • Graduate Nurse / Nurse Extern
  • Hemodialysis Tech
  • LPN (including Outpatient)
  • Medical Assistant
  • Nurse Anesthetist
  • Nurse Practitioner
  • Operating Room Aide
  • Patient Care Assistant
  • Patient Care Secretary
  • Patient Safety Companion
  • RNs
  • Social Worker  
  • Surgical Tech
  • Veurophysiology Tech

Please print and complete the following form in addition to the paperwork outlined above: