Employee AgreementPlease complete the following form to serve as your employee contract. Employee Name * First Name Last Name Phone * (###) ### #### DL Number * Birthdate * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Job Title * Direct Supervisor * Orientation Date * MM DD YYYY Probationary Period Ends * MM DD YYYY Employment Status * Regular Full Time Regular Part Time Temporary Full or Part Time Exempt Non-Exempt Starting Pay Rate * $ Emergency Contact * First Name Last Name Emergency Contact Phone Number * (###) ### #### Relationship to Employee * Primary Care Physician * First Name Last Name Physician Phone Number * (###) ### #### Insurance Provider and Policy Number * Thank you!
