Transcription
Welcome ToPulaski CountySpecial SchoolDistrict
Please print this New Hire Packet.Complete it and bring it with youto one of the scheduled New HireMeetings.The New Hire Paperwork and Insurancemeetings have been scheduled for thefollowing dates: Monday, July 8, at 1 p.m.Wednesday, July 10, at 1 p.m.Monday, July 15, at 1 p.m.Wednesday, July 17, at 1 p.m.Monday, July 22, at 1 p.m.Wednesday, July 24, at 1 p.m.Monday, July 29, at 1 p.m.Wednesday, July 31, at 1 p.m.Thursday, August 8, at 1 p.m.Register online atwww.pcssd.org/new-hire-2019Meetings will be held at PCSSD CentralOffice (925 East Dixon RoadLittle Rock, AR 72206)Human Resources will review your file with you at theNew Hire Meeting one-on-one to make sure we haveeverything that you need to get paid.
Required documentationfor your personnel fileIt is Mandatory to provide originalsof the following documents:v Arkansas Teaching CertificatePrinted from AELS with Commissioners Signaturev All College transcripts(official) not a color copyCopies, faxes or email are sufficientfor the following documents:v Social Security Cardv Drivers Licensev Birth Certificate or Passportv PRAXIS or NTE scores
Employee Informationfor Disaster Plan FormFill out all informationSpecial Skill Sets(Please check any boxes that pertain to you.)At least ONE Box will pertain to everyone!
Employee Information for Disaster PlanName:Employee Number:Home Number: Mobile Number:Emergency Contact:Name:Phone Number:Special Skill Sets: Please check any that pertain to youCPR CertifiedFood Service SupervisorAmateur Radio OperatorFirst Aid CertifiedRaces Certified – Radio AmateurCivil Emergency ServicesEmergency Medical TechnicianCertified CounselorParamedicFluent in SpanishLives 0 to 2 miles from workFire FighterLives 2 to 5 miles from workCrisis CounselorLives 5 to 10 miles from workAutomatic External Defibrillator(AED) TrainedRegistered NurseLives more than 10 miles fromworkActive or Reserve MilitarySearch and Rescue CertifiedHVAC MechanicLaw Enforcement OfficerLicensed PlumberLicensed Practical NurseAPSCN Student System TrainedMaster ElectricianOther Skills or Comments:
Notification LetterPlease read and sign.
PULASKI COUNTY SPECIAL SCHOOL DISTRICTHUMAN RESOURCES DEPARTMENT925 East Dixon Road/PO Box 8601 Little Rock, AR 72216Kristy Manees, Personnel Specialist501-234-2035 kmanees@pcssd.orgPhone 501-234-2035Fax 501-490-9897MEMOTO:New Certified EmployeesFROM:Kristy Manees, Certified Personnel Specialist IIRE:2019-2020 New Employee New Hire requirementsThe information listed below is provided to create your personnel file with PCSSD and to help guide you through your firstyear with us.When you come to Human Resources you we will complete several documents for your file. The following forms to besubmitted are included in the new hire packet online: Arkansas Teacher Retirement packet Background check release Arkansas Child Maltreatment form I-9 W-4 Substitute information Sheet Verification of Experience (for previous employment experience) Direct deposit authorizationIt is mandatory to provide originals of the following documents: AR Teaching Certificate (1 original) not a color copy All official college transcriptsCopies, faxes or email kmanees@pcssd.org are sufficient for the following documents: Social Security cardDriver’s licenseBirth certificate or a passportPRAXIS or NTE scoresIf you do not turn in one or more of the required documents it may result in forfeiture of benefits, non-payment, substituteor incorrect salary, or a delay in receiving your contract that may take 2-4 weeks to correct.It is your responsibility to submit the documentation to receive the salary and benefits you’re eligible to receive. If yourealize you have submitted the correct documentation and you are being paid incorrectly please contact us as soon aspossible. I can be contacted by phone at 501-234-2035, email kmanees@pcssd.org or fax at 501-490-9897.Thank you for joining us at PCSSD. I hope 2018-2019 is a productive and rewarding year.The New Hire Paperwork and Insurance meetings have been scheduled to meet at PCSSD Central Office (925 East Dixon Road,Little Rock, AR 72206) starting at 1:00 PM on the following dates:thththththstndJuly 8th, 10 ,15 , 17 , 22nd, 24 , 29 , 31 and August 8 .Sign up for a slot by visiting -certified1Check in at the front desk upon arrival. (Only 15 seats available) Please visit www.pcssd.org and print the new hire packetunder the Human Resource tab. Bring the completed packet to the new hire meeting along with the requireddocumentation.
ARTRS MembershipData FormPage 1Please print legibly and fill outthe first two sections completely.
School DistrictsForm # 1Revised 8/20091400 West Third, Little Rock, AR 72201Phone (501) 682-1517 or (800) 666-2877Fax (501) 682-2359Website - http://www.artrs.govMembership Data FormTo be Completed by MemberMember’s Social Security Number - -Name (Last, First, Middle)Maiden Name (If applicable)Addressq MaleqFemaleMember’s Date of BirthCounty of ResidenceCity State ZipMember’s Telephone NumberWork ()Home ()Name of Spouse (Last, First, Middle)Spouse’s Date of BirthMember’s Signature DateMember HistoryPrevious Service:Arkansas Public SchoolsArkansas State AgencyArkansas Highway DeptArkansas State PolicePrivate SchoolsOut-of-State ServiceActive Military oDatesNoDatesNoNoDatesDatesNoDatesNoDatesHave you ever participated in an Alternate Retirement Plan? (ie. TIAA-Cref, Valic)q Yesq NoHave you ever been a member of ATRS? q Yes q NoHave you ever received a refund?q Yes q NoTo be Completed by EmployerPulaski County Special School District00211School DistrictEmployer CodeMember’s Primary PositionIs Member a contract Employee?Employee enrolled asq Yesq Contributoryq NoIf yes, number of days?q NoncontributoryVerified by ATRSMember’s first paid day of service (Month/Day/Year)
ARTRS MembershipData FormLump Sum Death BenefitDisposition of Residue(Please fill out both forms provided.They are NOT the same.)
Form # 9Effective 7/1/20071400 West Third, Little Rock, AR 72201Phone (501) 682-1517 or (800) 666-2877Fax (501) 682-2359Website - http://www.artrs.govLUMP SUM DEATH BENEFIT - BENEFICIARY DESIGNATION FORMArkansas Code Annotated § 24-7-720 provides that upon the death of an active or retired member of theArkansas Teacher Retirement System (ATRS), with 10 or more years of actual service, a Lump Sum DeathBenefit payment in an amount set by the Board of Trustees shall be paid to such person(s) as the member hasdesignated in writing and filed with ATRS. Effective for a member dying after June 30, 2006, if there is nodesignated person surviving, the lump sum shall be paid to the member’s estate.Member’s Name Social Security NumberAddressCity State ZipPART 1 - Designation of Primary Beneficiary(ies)I hereby designate the following as the primary beneficiary(ies) of the Lump Sum Death Benefit due from ATRS. In theevent of my death, I authorize ATRS to make payment of the benefit to such beneficiary(ies) who are living at the time ofmy death. I understand that equal shares will be distributed among multiple surviving primary beneficiaries. At least oneprimary beneficiary must be listed.Name of Primary Beneficiary(ies)SSNDate of Birth RelationshipAddressPART 2 - Designation of Contingent Beneficiary(ies) - OPTIONALA contingent beneficiary will receive all benefits upon the member’s death only if all primary beneficiaries predecease themember. I hereby designate the following as contingent beneficiary(ies) of the Lump Sum Death Benefit. I understand thatequal shares will be distributed among multiple surviving contingent beneficiaries.Name of Contingent Beneficiary(ies)SSNDate of Birth RelationshipAddressThis Beneficiary Designation shall become effective on the date received by ATRS and shall supersedeand cancel all Lump Sum Death Beneficiary Designations filed previously with ATRS.Member Signature DateTo Be Completed By Notary PublicState of)County of )Subscribed and Sworn before me on this day of , 20 .Notary Signature My commission expires:(Notary Seal)
Form # 4Revised 3/20131400 West Third, Little Rock, AR 72201Phone (501) 682-1517 or (800) 666-2877Fax (501) 682-2359Website - http://www.artrs.govDISPOSITION OF RESIDUE - BENEFICIARY DESIGNATION FORMIf a member of the Arkansas Teacher Retirement System (ATRS) dies with residual account balance(s) standingto the member’s credit at his/her death, the residual balance(s) will be paid to such person(s) as the memberhas designated in writing and filed with ATRS. Effective for a member dying after June 30, 2006, if there is nodesignated person surviving, the residue shall be paid to the member’s estate. [Note that the residual contributionand T-DROP balances are only paid to beneficiaries if a survivor or retirement option annuity does not becomepayable at the member’s death.]Member’s Name Social Security NumberAddressCity State ZipPART 1 - Designation of Primary Beneficiary(ies)I hereby designate the following as the primary beneficiary(ies) of any residual balance due from ATRS. In the event ofmy death, I authorize ATRS to make payment of the benefit to such beneficiary(ies) who are living at the time of mydeath. I understand that equal shares will be distributed among multiple surviving primary beneficiaries. At least oneprimary beneficiary must be listed.Name of Primary Beneficiary(ies)SSNDate of BirthRelationshipAddressPART 2 - Designation of Contingent Beneficiary(ies) - OPTIONALA contingent beneficiary will receive all benefits upon the member’s death only if all primary beneficiaries predecease themember. I hereby designate the following as contingent beneficiary(ies) of any residual balance. I understand that equalshares will be distributed among multiple surviving contingent beneficiaries.Name of Contingent Beneficiary(ies)SSNDate of BirthRelationshipAddressThis Beneficiary Designation shall become effective on the date received by ATRS and shall supersedeand cancel all Residue Designations filed previously with ATRS.Member Signature DateTo Be Completed By Notary Public)State ofCounty of )Subscribed and Sworn before me on this day of , 20 .Notary Signature My commission expires:(Notary Seal)
Form I-9 EmploymentEligibility VerificationPlease fill out section 1Be sure to sign and date
USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 08/31/2019 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,during completion of this form. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify whichdocument(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employan individual because the documentation presented has a future expiration date may also constitute illegal discrimination.Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterthan the first day of employment, but not before accepting a job offer.)Last Name (Family Name)Apt. NumberAddress (Street Number and Name)Date of Birth (mm/dd/yyyy)Middle InitialFirst Name (Given Name)U.S. Social Security Number-Other Last Names Used (if any)StateCity or TownZIP CodeEmployee's Telephone NumberEmployee's E-mail Address-I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident(Alien Registration Number/USCIS Number):4. An alien authorized to workuntil (expiration date, if applicable, mm/dd/yyyy):Some aliens may write "N/A" in the expiration date field. (See instructions)QR Code - Section 1Do Not Write In This SpaceAliens authorized to work must provide only one of the following document numbers to complete Form I-9:An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.1. Alien Registration Number/USCIS Number:OR2. Form I-94 Admission Number:OR3. Foreign Passport Number:Country of Issuance:Signature of EmployeeToday's Date (mm/dd/yyyy)Preparer and/or Translator Certification (check one):I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct.Today's Date (mm/dd/yyyy)Signature of Preparer or TranslatorLast Name (Family Name)Address (Street Number and Name)First Name (Given Name)City or TownStateZIP CodeEmployer Completes Next PageForm I-9 07/17/17 NPage 1 of 3
USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 08/31/2019Section 2. Employer or Authorized Representative Review and Verification(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. Youmust physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Listsof Acceptable Documents.")Employee Info from Section 1Last Name (Family Name)List AFirst Name (Given Name)ORList BM.I.Citizenship/Immigration StatusANDList CIdentityIdentity and Employment AuthorizationEmployment AuthorizationDocument TitleDocument TitleDriver's License / ID CardDocument TitleIssuing AuthorityIssuing AuthorityDocument NumberDocument NumberIssuing AuthoritySS Admin / US GovernmentDocument NumberExpiration Date (if any)(mm/dd/yyyy)Expiration Date (if any)(mm/dd/yyyy)Expiration Date (if any)(mm/dd/yyyy)State of ArkansasSocial Security CardDocument TitleQR Code - Sections 2 & 3Do Not Write In This SpaceAdditional InformationIssuing AuthorityDocument NumberExpiration Date (if any)(mm/dd/yyyy)Document TitleIssuing AuthorityDocument NumberExpiration Date (if any)(mm/dd/yyyy)Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge theemployee is authorized to work in the United States.The employee's first day of employment (mm/dd/yyyy):Signature of Employer or Authorized RepresentativeLast Name of Employer or Authorized Representative(See instructions for exemptions)Today's Date (mm/dd/yyyy)Title of Employer or Authorized RepresentativeFirst Name of Employer or Authorized RepresentativeEmployer's Business or Organization Address (Street Number and Name)925 East Dixon RoadCity or TownLittle RockEmployer's Business or Organization NamePulaski Co. Special School DistrictStateARZIP Code72206Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)A. New Name (if applicable)Last Name (Family Name)B. Date of Rehire (if applicable)First Name (Given Name)Middle InitialDate (mm/dd/yyyy)C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishescontinuing employment authorization in the space provided below.Document TitleDocument NumberExpiration Date (if any) (mm/dd/yyyy)I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and ifthe employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.Signature of Employer or Authorized RepresentativeForm I-9 07/17/17 NToday's Date (mm/dd/yyyy)Name of Employer or Authorized RepresentativePage 2 of 3
LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIREDEmployees may present one selection from List Aor a combination of one selection from List B and one selection from List C.LIST ADocuments that EstablishBoth Identity andEmployment Authorization1. U.S. Passport or U.S. Passport Card2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machinereadable immigrant visa4. Employment Authorization Documentthat contains a photograph (FormI-766)5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:a. Foreign passport; andb. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;and(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.6. Passport from the Federated States ofMicronesia (FSM) or the Republic ofthe Marshall Islands (RMI) with FormI-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMILIST BLIST CDocuments that EstablishEmployment AuthorizationDocuments that EstablishIdentityORAND1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address3. School ID card with a photograph4. Voter's registration card5. U.S. Military card or draft record6. Military dependent's ID card7. U.S. Coast Guard Merchant MarinerCard8. Native American tribal document9. Driver's license issued by a Canadiangovernment authorityFor persons under age 18 who areunable to present a documentlisted above:1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:(1) NOT VALID FOR EMPLOYMENT(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal4. Native American tribal document5. U.S. Citizen ID Card (Form I-197)6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)7. Employment authorizationdocument issued by theDepartment of Homeland Security10. School record or report card11. Clinic, doctor, or hospital record12. Day-care or nursery school recordExamples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).Refer to the instructions for more information about acceptable rece
Licensed Practical Nurse APSCN Student System Trained Master Electrician . The information listed below is provided to create your personnel file with PCSSD and to help guide you through your first . Check in at the front desk upon arrival. (Only 15 seats available) Ple
