NEW EMPLOYEE REQUEST FORM

Fields marked with a * are required.

    Director Contact Information

    Director – Name*
    Director – Email Address*
    Director – Phone Number*

    Employee information

    First Name*
    Last Name*
    Employee’s personal E-Mail address*
    Date of Birth*
    Gender*
    Ethnicity*
    Address*
    City*
    State*
    Zip*
    Home Phone
    Cell Phone

    Position Information

    Job Title*
    Facility (Check primary site)*
    Department*
    Hire Date*
    Start Date*
    Ending Date (if any)
    Employment Type
    Supervisor (if not a director)
    Employee will need access to KIPU.
    Employee has credentials (to be verified by HR).
    Employee will need a drug screen.
    Employee will need a TB test.
    Employee is new to MARR and needs to complete new hire orientation.
    Notes (work phone number, replacing former employee, other information)
    NOTE: Filling out this form will begin the process of a background check, drug screen, and access to Pathway for Staff. The employee MUST have cleared a background check, drug screen, and have completed MARR orientation before they can have access to MARR systems and begin working. EMPLOYEES CANNOT BEGIN EMPLOYMENT UNTIL THESE ARE COMPLETED. They should turn in their orientation certificate of completion to you on their first day. Contact Brenda Bray in HR at 678-805-5108 for any questions on the background check and drug screen. Contact MARR IT at 678-805-5120 with any questions on the orientation.

    *Your request will be processed within 1 business day.