Payrolling

Requisition Form

Please note, all fields are required

Information About You (Requestor)
Company Name
Requestor's Name
Requestor's Phone Number
Requestor's Department
Requestor's Title
Requestor's Email
Information About The Worker's Manager
Manager's Name
Manager's Department
Manager's Phone Number
Manager's Email
Information About The Worker To Be Payrolled
Worker's Name
Worker's Phone Number
Worker's Email
Worker Pay Rate
Start Date
End Date
Expected Number of Hours Worked Per Week
Will the worker require a work permit?
Yes
No
OPT or CPT endorsement?
Yes
No
Is driving or travel required?
Yes
No
Information About The Worker's Assignment

Address where work will be performed
Assignment Address
City
Job Title
Zip
Type of Worker - ?
State
In what environment will the work be performed?
Will the worker be required to lift more than 20lbs, work at heights more than 2 feet off the ground, use equipment other than standard office equipment, and/or be required to drive any motorized vehicles during the course of their assignment?
Enter Job Description below OR Upload File here:
Additional Comments

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