ASSOCIATE FACULTY

Please check the following to indicate presentation to new employee.

• ____ A-4 (Arizona State Withholding)
• ____ W-4 (Federal Withholding)
• ____ Direct Deposit Authorization Form
• ____ Loyalty Oath - PART ONE & Statement of Registration Status - PART TWO
• ____ Anti-Discrimination/Anti-Harassment/Constructive Discharge Acknowledgment
• ____ Applicant Background Questionnaire (voluntary)
• ____ I-9 (Employment Eligibility Verification) (Notary Form for out of county use only)
• ____ Arizona State Retirement Declaration
• ____ Social Security Opt-Out Form

My signature indicates that I was provided with the forms and information listed above.

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Employee Signature                                                                   Date

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Supervisor Signature                                                                  Date