New Employee Orientation Checklist and Certification of Receipt (Word)

NEW EMPLOYEE ORIENTATION CHECKLIST Regular Employees Eligible for Full Benefits Below is a checklist containing information that may be provided to you upon hire or as part of your employee orientation program. After reviewing the information that has been checked, please sign and date below and retain a copy of this form for your records.

MATERIALS FOR ALL EMPLOYEES MATERIAL FOR BENEFITS-ELIGIBLE EMPLOYEES To Be Given To All Employees: To Be Given To Regular Employees Eligible for Benefits: X Appointment Letter (All materials may be obtained electronically) X Employee Assignment Form X Patent and Inventions Policy Statement X Accessing Benefits Information on the RF Web site X SUNY Computer Software Policy Statement X Benefits Handbook X Employment Eligibility Verification Form (I-9) X Your Benefits: A Quick Reference Guide X Fraud and Whistleblower Policy X Long-Term Care Brochure X Affordable Care Act Marketplace Notice X Benefits Enrollment Form X Code of Conduct X Benefits Enrollment Form Instructions X Annual Acknowledgment and Certification of Compliance with X Health Plan Rates the Code of Conduct X COBRA General Notice X Employee Handbook X Benefits Booklet (Empire PPO and Prescription Drug) X Employee Handbook Acknowledgment and Agreement X HMO Materials X Conflict of Interest Policy Statement X Summary of Benefits and Coverage (area health plans) X Procedure for Investigating Conflict of Interest X Delta Dental Fact Sheet X Statement of Policy on Equal Employment Opportunity X Vision Brochure X Nonharassment in the Workplace Policy X Life Insurance Enrollment Kit X RF Overview X Notice of Privacy Practices (PHI) To Be Given to Salaried Employees Only (with Regular, X Employee Work Schedule Info (as provided by supervisor) Biweekly pay) in Addition to the Material Above: X Payment Method – Direct Deposit of Salary form & Payment X Flexible Benefits Plan Reference Guide Method – Additional Direct Deposit Information form X Voluntary Short Term Disability Enrollment Kit X Applicable NYS Wage Notification Form Campus-specific or other information which may include: RETIREMENT MATERIALS X Tuition Waiver Program information (full time employees) To Be Given To Regular and Summer Employees: X Employee Assistance Program (EAP) Information X Campus Holiday Schedule X Your RF Benefits: Basic Retirement RF web page X Bloodborne Pathogens Notice X Your RF Benefits: Optional Retirement RF web page X RF-Ride Brochure X Basic Retirement – Employment Service Credit RF web page X Campus Wellness and Diversity Programs (if applicable) X TIAA-CREF microsite (www.tiaa-cref.org/rfsuny) X UAlbany Employee Policies X Fee disclosure, TIAA-CREF website

TAX MATERIALS FOR ALL EMPLOYEES ONLINE ACCESS INFORMATION X IRS Employee's Withholding Allowance Certificate (W-4) To Be Given to All Employees X NYS IT-2104 (Employee’s Withholding Allowance Certificate) X www.rfsuny.org X Login/Self Service User Name and Password Additional Tax Forms For US Citizens, Permanent Residents, Resident Aliens only (choose applicable form): X NYS IT 2104-E (Certificate of Exemption from Withholding) X NYS IT-2104.1 (Certificate of Nonresidence and Allocation of Withholding Tax X Resident Alien treaty exempt – IRS W-9 X Expatriate exemption IRS 673

Additional Form For Nonresident Aliens Only (if applicable): X IRS 8233 and supporting statement from IRS Pub 519

I have received copies of all checked items that relate to my employment status. I am also aware that I have online access to Research Foundation employee information.

______Employee Signature Print Employee Name Date Original - Personnel File Copy/Duplicate – Employee Rev. September 2013