First Name
    Middle Name
    Last Name
    DOB
    SSN
    Phone
    Address
    City
    State
    ZIP
    Full Time/Part Time? Full TimePart Time
    Emergency Contact Name
    Emergency Contact Relationship
    Emergency Contact Phone
    Emergency Contact Address
    Emergency Contact City
    Emergency Contact State
    Emergency Contact ZIP
    License Number
    License Expiration
    PTCB Certification Number
    PTCB Expiration
    Hourly Wage
    Job Title
    Location (7 choices)
    Bank Routing Number
    Bank Account Number
    Does employee need Microsoft Office and email access? YesNo
    Does employee need access to SharePoint? YesNo
    Does employee need WhenIWork access? YesNo
    Does employee need EnterpriseRx access? YesNo
    Does employee need Point-of-Sale access? YesNo
    Four digit alarm PIN
    Four digit time-clock PIN
    W4 Completion Upload Form