Document Checklist for Internationally Based Short-Term Employees
(U.S. Citizens/Residents)
Print and refer to this checklist as a guide to completing and returning the appropriate employment paperwork. See instructions below.
1. Click on underlined links to view documents and complete forms.
2. Complete, print, and submit the documents in Section 1, 2 and 3.
3. Read documents in Section 4 and 5 and save any materials you wish to refer to at a later time.
Once completed, check each box on the printed checklist to acknowledge that you have read and understand the documents. Please return this signed checklist with all the completed forms to the HR Service Center 5 days prior to your date of employment.
Once your completed forms are returned, you can expect your information will be sent to CIGNA Global Health and you will be mailed your medical insurance cards via pouch. Please allow 6 to 8 weeks from your start date for delivery. If you require medical assistance prior to this, contact the HR Service Center at HRServiceCenter@care.org.
SECTION 1: Personnel Forms – PRINT & RETURN FORMS ONLY
□ Signed original Offer Letter
□ Employee Basic Data Form
□ W-4 Form, Employee's Witholding Allowance Certificate
□ Form 673 (Statement for Claiming Exemption form Withhold on Foreign Earned Income Eligible for the Exclusion(s) Provided by Section 911)
□ Conflict of Interest Statement
□ Employee Confidentiality Agreement
□ Indebtedness Statement
□ Vehicle Policy (If this form is not signed by the Country Director, a monthly fee of $65 will be assessed)
CARE USA Vehicle Policy Vehicle Waiver Form
SECTION 2: Banking Options (You can only choose 1 option) – PRINT & RETURN FORMS ONLY
□ Payment Options & Information (Select only one option)
1. Direct Deposit Authorization Form (U.S. bank account only)
2. Wire Transfer Form
3. Check (Default payment option)
SECTION 3: Benefits Forms and Information – PRINT & RETURN FORMS ONLY
□ Benefit Enrollment Form
□ Beneficiary Forms (Complete all three)
Accidental Death & Dismemberment Business Travel Accident ING Life Insurance
□ CIGNA Global Health - New Member Kit
□
CARE Retirement Savings Plan: Retirement Planning Workbook (Eligible after 1 year of service)
Enrollment Form Beneficiary Designation Form
If you do not elect or waive benefit options or do not return enrollment forms within 31 days of your start date, you will not receive voluntary benefits and will not be eligible to enroll until the next annual open enrollment or during a life event change.
SECTION 4: Supplemental Benefits Information
(Please read the following material. You do not need to return the documents; however, please check the boxes to acknowledge you have read and understood the materials)
□ International SOS Card & Evacuation Information
Access International SOS Country/Security Guidelines at: www.internationalsos.com.
Log in using CARE’s membership number 11BCPA000091
□ Employee Assistant Program
□ Accidental Death & Dismemberment
□
Disability
Long-term Disability Short-term Disability
□ Your Group Life Insurance Plan
SECTION 5: Policy Information
(Please read the following material. You do not need to return the documents; however, please check the boxes to acknowledge you have read and understood the materials)
□ Employee Handbook - http://handbook.care.org
□ Code of Conduct & Accountability to Program Participant Communities
□ Code of Ethics & Conduct
□ HIPAA Privacy Policy
Please sign, print your name and date below, confirming that you have read and completed all the necessary documents. Please note that delays in receiving completed paperwork will delay processing and hence prevent your payroll and benefits coverage from being activated. Your quick response is imperative in successfully onboarding you to CARE. For questions & support please contact HRServiceCenter@care.org or call +1.404.979.9511.
_______________________________ ____________________________ ________________
Employee Name Signature Date
Documents can be emailed, faxed or mailed to:
CARE USA
c/o Human Resources
151 Ellis Street
Atlanta, GA 30303
Fax: +1.404.589.2630
Email: HRServiceCenter@care.org
For HR Use Only
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