Step
1
of
6
16%
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Today's Date
Month
Day
Year
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Today's Date Full
MM slash DD slash YYYY
About You
Your Legal Name
(Required)
First
Middle
Last
Date of Birth
(Required)
Month
Day
Year
SSN Number
(Required)
Your Address
(Required)
Street Address
Address Line 2
City
ZIP Code
About You Continued
Gender
Male
Female
Non-Binary
Prefer Not to Say
Other
Marital Status
Single
Married
Separated
Divorced
Widowed
Prefer Not to Say
Race/Ethnicity
Hispanic or Latino
White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Two or More Races
Prefer Not to Say
Your Contact Information
Your Personal Email Address
(Required)
Email Address
Confirm Email Address
Your Personal Phone Number
(Required)
Employment Information
Job Title
Building / Department
Date of Hire
MM slash DD slash YYYY
Employment Type
Certified
Classified
Administrator
Substitute
Full-Time or Part-Time
Full-Time
Part-Time
Hourly / Non-Exempt
Salaried / Exempt
Union Membership
None
OEA
OESPA
Emergency Contacts
Please provide two emergency contacts.
(Required)
Name
Relationship
Address
Phone Number
Add
Remove
Pay Election
I would like to receive my pay in the following manner:
Hourly
24-Pay
Signature
(Required)
My signature below indicates the following:
●I understand that my above election is binding for the remainder of this school year and can only be changed at the beginning of a school year via written request to the District Offi ce before the beginning of said school year. ● I understand the difference between hourly and 24-pay and my above election was made voluntarily.
Direct Deposit Authorization
Bank Name
Routing Number
Account Number
Account Number Confirmation
Account Type
Checking
Savings
Allocation Method
100% to Primary Account
Split By Percentage
Split By Dollar Amount
Signature
(Required)
My signature below indicates the following:
●I understand that my above election is binding for the remainder of this school year and can only be changed at the beginning of a school year via written request to the District Offi ce before the beginning of said school year. ● I understand the difference between hourly and 24-pay and my above election was made voluntarily.
