Document Checklist for U.S. Based Employees
Print and refer to this checklist as a guide to completing and returning the appropriate employment paperwork. See instructions below.
1. Click the print icon below to print and complete the checklist.
2. Click on underlined links to view documents and complete forms.
3. Complete, print, and submit the documents in Section 1 and 2.
4. Read documents in Section 3 and 4 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.
SECTION 1: Personnel Forms – PRINT & RETURN FORMS ONLY
Must be printed and returned 5 days before your start date.
□ Signed original Offer Letter
□ Employee Basic Data Form
□ I-9 Form, Employment Eligibility Verification (I-9 documentation is required to work in the U.S.)
I-9 Instructions Agent Form I-9 Form I-9 Example
□ Employee Confidentiality Agreement
□ Indebtedness Statement
□ W-4 From, Employee's Withholding Allowance Certificate
□ Non US Resident IRS Form W-4 Instructions
□ State Tax Form, Employee's Withholding Allowance Certificate
Please pick your appropriate State of Residency
California Georgia Illinois Maryland Massachusetts New Jersey
New York N. Carolina Ohio Virginia Washington DC West Virginia
□ Important Tax Information US Citizens and Residents
□ Payroll Direct Deposit Authorization Form (U.S. bank account only)
□ Conflict of Interest Statement (General or Fundraiser form as noted on your Employment Information Form)
General Fundraiser
SECTION 2: Benefits Forms and Information – PRINT & RETURN FORMS ONLY
□ A Guide to Your Benefits
Note: If you want to waive all benefits, the Waiver form must be completed on page 2 of the Enrollment Form.
Benefit Enrollment Form Statement of Domestic Partnership (If applicable)
□ Beneficiary Forms
(Complete all three)
Accidental Death & Dismemberment Business Travel Accident ING Life Insurance
□ Medical/Pharmacy/Dental Insurance Plan - Employee Member Kit
□ CARE Retirement Savings Plan: Retirement Planning Workbook
Important Information Beneficiary Designation Form
Resident Enrollment Form Non-Resident Enrollment 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 3: 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)
□ Flexible Spending Accounts Health FSA Eligible Expenses
□ International SOS Card & Evacuation Information
Access International SOS Country/Security Guidelines at: www.internationalsos.com.
Log in using CARE’s membership number 11BCPA000091
□ Health Club Reimbursment
□ AD&D Insurance Certificate Class – 1
□ Disability
Long-term Disability Short-term Disability
□ Your Group Life Insurance Plan
SECTION 4: 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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