New Hire HR Form

New Hire HR Form
First Name*
Last Name*
Supervisor's Name*
Date of Hire*

MonthDayYear
Date
Have you worked at a Y before?*

YesNo
Emergency Contact Name*
Emergency Contact Phone Number*
EEOC Information (voluntary)
Ethnicity (check one)

AsianBlackHispanic or LatinoMixed (2 or more)Hawaiin or Othe rPacific Islandernative American or Native AlaskanWhite (not Hispanic)
Gender (check one)

FemaleMaleNon-binary
Marital Status (check one)

SingleMarriedDomestic Partner
Veteran Status (check one)

Recent VeteranEligible VeteranDisabled Veteran
Payroll Deduction and Required Forms
By checking the boxes below, you are authorizing a Payroll Deduct if necessary

Background Check, National ($8.50)Name badge, if not returned ($5.00)Key, if not returned ($25.00)
Other forms if you choose to participate:

Staff Membership Form (please download from the link below, print, complete, and sign and return it to the Front Desk at your branch.Staff Annual Campaign (download from the link below)United Way (download from the link below)
Other forms*

YRF 403b - The 403b Form, please download it from the link below, print, add a $ or % amount, sign and attach it below OR:Check here to decline
Below are the links for additional forms if needed:

YRF 403b

Staff Membership Form

Staff Annual Campaign
Upload Signed Document(s) (add only those required)

Max combined size: 10MB File Formats: pdf, doc, docx, xls, xlsx, txt, rtf, jpg, jpeg, png
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Comments or special instructions:
I attest that the information that I have provided is accurate to the best of my ability and I authorize the ORYMCA to deduct the amount indicated above from my paycheck.*

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Type a question
Should be Empty:

New Hire HR Form

EEOC Information (voluntary)

Payroll Deduction and Required Forms