Client ID
Company Name
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New Employees State of Residence
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Position
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Job Duties
Employment Status (Exempt or Non-Exempt)
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Please Select
Exempt
Non-Exempt
FLSA Non-Exempt - Employee must be paid hourly and hours tracked, must be paid for all hours worked.FLSA Exempt - Employee is exempt from overtime only if they meet qualifications for meeting specific exemptions as outlined by federal or state FLSA, they are paid a weekly amount, should be paid in whole day increments, not necessary to track hours.
EEO Code
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Administrative Support Workers
Craft Workers
Executive/Senior Level Officials and Managers
First/Mid-Level Officials and Managers
Laborers and Helpers
Operatives
Professionals
Sales Workers
Service Workers
Technicians
An EEO Job Group Code is part of the Equal Employment Opportunity (EEO) reporting system used in the United States to classify jobs for the purpose of tracking and reporting on employment diversity and ensuring compliance with EEO laws. These codes are used in EEO-1 reports, which are mandatory filings for certain employers.
Workers Comp Code
Workers’ comp codes are four-digit codes that identify types of work. Insurance companies use these codes to help estimate risk and determine workers’ compensation insurance costs. Insurance agents or underwriters can review the codes in the National Council on Compensation Insurance (NCCI) Scopes Manual. Each workers’ comp class code includes information on the losses accumulated by specific types of work. From there, insurance companies can determine workers’ compensation costs. Generally, the more risk a worker faces, the higher the cost of workers’ compensation insurance in the industry. For example, construction workers likely have a higher level of risk than graphic designers. The workers’ compensation codes for both jobs would reflect the difference in risk. Various contractors also have different codes and risk levels. Plumbers, for example, have a different code from Roofers. Workers’ comp class codes are a starting point for insurance companies as they determine cost and provide coverage to your business.
SOC Code
SOC, or Standard Occupational Classification, codes classify workers into occupational categories. Standard Occupational Classification is a standard system that makes it easier for federal agencies to collect, calculate, and disseminate occupational data.
Amount of Time in Office
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100%
75%
50%
25%
<25%
Does this position drive for company business?
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Yes
No
Does this position operate equipment?
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Yes
No
Does this position work in the field?
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Yes
No
Does this position work in a healthcare facility?
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Yes
No
Does this position have any contact with patients
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Please Select
Yes
No
If we have any questions, we will contact the person who submitted the form.
Name of Person Submitting Form
First Name
Last Name
Email of Person Submitting Form
example@example.com
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