Revised 03/2020

CITY OF ARLINGTON

NEW EMPLOYEE PROCESSING PROCEDURE

INSTRUCTIONS TO NEW PART-TIME OR SEASONAL EMPLOYEES:

Welcome to the City of Arlington! If you have not done so already, please call Human Resources at 817-459-6868 to schedule a time to complete your New Employee Paperwork on your first day. The Human

Resources Department is open from 8 a.m. to 5 p.m. and is located at 101 S. Mesquite Street, Suite 790 (7th

floor), Arlington, TX 76010. If arriving late, please call 817-459-6869.

YOU ARE REQUIRED TO ARRIVE WITH THE FOLLOWING MATERIALS IN HAND:

Your Confirmation of Employment Letter, which states your salary and position information.

Your completed New Hire Packet.

Your documentation that will establish both identity and employment eligibility.

Please refer to the “List of Acceptable Documents” located within this packet for a list of acceptable documentation. Prospective employees who do not have these documents must obtain a replacement before being hired. If a receipt is presented, you must bring in the actual document once received.

Your Beneficiary/Dependent Information.

You are eligible for the City’s retirement program. Please complete the following information on your beneficiaries for this beneift. Accurate and complete data will ensure timely completion.

Beneficiary/Dependent Name:

Address:

Social Security#:

Date of Birth:

Please complete this page and bring it with you along with your new hire packet.

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

1. U.S. Passport or U.S. Passport Card

3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

4. Employment Authorization Document that contains a photograph (Form I-766)

5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

Documents that Establish Both Identity and

Employment Authorization

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

b. Form I-94 or Form I-94A that has the following:(1) The same name as the passport;

and(2) An endorsement of the alien's

nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

a. Foreign passport; and

For persons under age 18 who are unable to present a document

listed above:

1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

9. Driver's license issued by a Canadian government authority

3. School ID card with a photograph

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner Card

8. Native American tribal document

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish Identity

LIST B

OR AND

LIST C

7. Employment authorization document issued by the Department of Homeland Security

1. A Social Security Account Number card, unless the card includes one of the following restrictions:

2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)

3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

4. Native American tribal document

6. Identification Card for Use of Resident Citizen in the United States (Form I-179)

Documents that Establish Employment Authorization

5. U.S. Citizen ID Card (Form I-197)

(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION

(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3Form I-9 10/21/2019

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

This OrganizationParticipates in E-Verify

This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization.

IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including terminating your employment.

Employers may not use E-Verify to pre-screen job applicants and may not limit or influence the choice of documents you present for use on the Form I-9.

To determine whether Form I-9 documentation is valid, this employer uses E-Verify’s photo matching tool to match the photograph appearing on some permanent resident cards, employment authorization cards, and U.S. passports with the official U.S. government photograph. E-Verify also checks data from driver’s licenses and identification cards issued by some states. If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the employment eligibility verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 800-255-7688, 800-237-2515 (TDD) or at www.justice.gov/crt/osc.

N O T I C E: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.

E-Verify Works for Everyone For more information on E-Verify, please contact DHS: 888-897-7781

www.dhs.gov/E-VerifyThe E-Verify logo and mark are registered trademarks of Department of Homeland

Security. Commercial sale of this poster is strictly prohibited.

Esta organización participa en E-Verify

Este empleador proporcionará a la Administración del Seguro Social (SSA, por sus siglas en inglés) y, de ser necesario, al Departamento de Seguridad Nacional (DHS, por sus siglas en inglés) la información incluida en el Formulario I-9 de todo empleado nuevo con el propósito de confirmar su autorización de trabajo.

IMPORTANTE: Si el gobierno no puede confirmar que usted tiene autorización para trabajar, el empleador debe suministrarle las instrucciones por escrito y darle la oportunidad de ponerse en contacto con DHS o SSA antes de sancionarlo de cualquier forma o finalizar la relación laboral.

Los empleadores no pueden utilizar E-Verify para realizarpreselecciones de solicitantes y no pueden limitar ni influenciar la selección de los documentos que usted presente para su inclusión en el Formulario I-9.

Para determinar si los documentos incluidos en el Formulario I-9 son válidos, este empleador utiliza la técnica de comparación fotográfica para comparar la fotografía que aparece en las Tarjetas de Residente Permanente, Tarjetas de Autorización de Empleo y pasaportes de los EE. UU. con la fotografía oficial del gobierno de los EE. UU. Asimismo, E-Verify verifica los datos incluidos en licencias de conducir y tarjetas de identificación emitidas por algunos estados. Si considera que su empleador ha infringido sus responsabilidades en virtud de este programa o lo ha discriminado durante el proceso de verificación de la elegibilidad de empleo por su origen nacional o estatus de ciudadanía, comuníquese con la Oficina del Consejero Especial llamando al 800-255-7688, 800-237-2515 (para personas con impedimentos auditivos) o visitando www.justice.gov/crt/osc.

E-Verify funciona para todos

Para obtener más información sobre E-Verify, comuníquese con DHS al:

888-897-7781

www.dhs.gov/E-Verify

A V I S O: La ley federal exige a todos los empleadores que

verifiquen la identidad y la elegibilidad de empleo de todas las personas contratadas en los Estados Unidos.

El logotipo y la marca de E-Verify son marcas registradas del Departamento de Seguridad Nacional. Queda estrictamente prohibida la venta comercial de este afiche.

IF YOU HAVE THE RIGHT TO WORK…

Don’t let anyone take it away.

There are laws to protect you from discrimination in the workplace.

You should know that…

In most cases, employers cannot deny you a job or fire you because of your national origin or citizenship status or refuse to accept your legally acceptable documents.

Employers cannot reject documents because they have a future expiration date.

Employers cannot terminate you because of E-Verify without giving you an opportunity to resolve the problem.

In most cases, employers cannot require you to be a U.S. citizen or a lawful permanent resident.

Contact IER

For assistance in your own language Phone: 1-800-255-7688 TTY: 1-800-237-2515

Email us IER@usdoj.gov

Or write to U.S. Department of Justice – CRT Immigrant and Employee Rights – NYA 950 Pennsylvania Ave., NW Washington, DC 20530

If any of these things happen to you, contact the Immigrant and Employee Rights Section (IER).

Immigrant and Employee Rights Section U.S. Department of Justice, Civil Rights Division www.justice.gov/ier

SI USTED TIENE DERECHO A TRABAJAR…

No deje que nadie se lo quite.

Existen leyes que lo protegen contra la discriminación en el trabajo.

Usted debe saber que…

En la mayoría de los casos, los empleadores no pueden negarle un empleo o despedirlo debido a su nacionalidad de origen o estatus de ciudadanía, ni tampoco negarse a aceptar sus documentos válidos y legales.

Los empleadores no pueden rechazar documentos porque tengan una fecha de vencimiento futura.

Los empleadores no pueden despedirlo debido a E-Verify sin darle una oportunidad de resolver el problema

En la mayoría de los casos, los empleadores no pueden exigir que usted sea ciudadano estadounidense o residente legal permanente.

Comuníquese con la IER

Para ayuda en su propio idioma: Teléfono: 1-800-255-7688 TTY: 1-800-237-2515

Mándenos un correo: IER@usdoj.gov

O escríbanos a: U.S. Department of Justice – CRT Immigrant and Employee Rights – NYA 950 Pennsylvania Ave., NW Washington, DC 20530

Si alguna de estas cosas le ha sucedido, comuníquese con la Sección de Derechos de Inmigrantes y Empleados (IER, por sus siglas en inglés)

Sección de Derechos de Inmigrantes y Empleados Departamento de Justica de los EE. UU., División de Derechos Civiles

www.justice.gov/ier

www.justice.gov/crt-about/espanol/ier

City of Arlington Terminal Pay Beneficiary Designation

I _________________________ with Kronos ID# ______________, understand that in the

event of my death, my wages or other types of pay (i.e. final regular pay, overtime pay, holiday

pay, sick and vacation leave hours, stability pay, current base pay for 2 pay periods, ETC) will be

paid to the person designated by me on this form. In this regard, I authorize the City of Arlington

to make my final paycheck payable to the person designated by me on this form. Pursuant to

the requirements of Vernon’s Texas Probate Code Section 450, I convey my final paycheck to:

I understand that this written form will convey my final paycheck outside of my Last Will and

Testament, if I have a Will, or outside of the intestacy statutes, if I do not have a will. Therefore,

no persons other than the person listed above shall have any right to my final paycheck and will

not be able to obtain this money from the City of Arlington.

Employee Signature: _________________________________ Date: ____________________

*Privacy Act of 1974 Disclosure: Authority: Finance Payroll & Human Resources, City of Arlington. Routine Users:

The SSN is used to verify identity and to track persons in various systems. Disclosure: Voluntary. However, failure

to furnish SSN may result in delay in processing this form.

_____________________________________________________________ ______________________ First Name Middle Name Maiden Name Last Name Relationship

__________________ _________ ________ ____________________ PRIMARY or SECONDARY

Phone Number Date of Birth *Social Security Number ↑ Circle Beneficiary Type ↑

_______________________________________________________________________________________ Address City State Zip Code

_____________________________________________________________ ______________________ First Name Middle Name Maiden Name Last Name Relationship

__________________ _________ ________ ____________________ PRIMARY or SECONDARY

Phone Number Date of Birth *Social Security Number ↑ Circle Beneficiary Type ↑

_______________________________________________________________________________________ Address City State Zip Code

09/2019

12/2015

CITY OF ARLINGTON

AT-WILL EMPLOYMENT

Please make yourself aware of the following employment policy noted in the City of Arlington’s

Personnel Policy:

105.04 DISMISSAL

A. “At-will” employees, as listed in Appendix D to Chapter 101.00 (probationary, part-

time, seasonal, or temporary employees, council appointees, Deputy City Managers,

department heads, assistant city attorneys, the heads of organizational units, and persons

in other specific positions identified in Appendix D to this Chapter, and those other

employees designated at the time of hiring/promotion by the City Manager as "at will"

employees) may be transferred, demoted, or dismissed from city employment at any time,

with or without cause. Such employees have no property interest in continued

employment with the City, and their dismissal is not appealable.

I _________________________, have read the above City of Arlington employment policy and

understand that I may be dismissed from my duties as an “at-will” employee with the City of

Arlington at any time and without cause.

Signature Date

CITY OF ARLINGTON

OPEN RECORDS AND YOUR PERSONAL INFORMATION

The Texas Public Information Act says that any person may ask to view or receive copies of any information held by the City. Most of the City’s information is public, meaning the City will release the information upon request. However, certain information is not public and will not be released.

You may choose to keep the following information about yourself private (meaning it will never be released under a Public Information Act request):

• Home address• Personal phone numbers• Social security number• Emergency contact information• Any information that reveals whether you have family members

If you want to keep this information private, then you must sign the statement below and return this form to the City’s Human Resources Department. If you do not sign and return this form, then your information may be released under a Public Information Act request.

(Note: Certain other information about you is always private, even if you do not complete this form. For example, the City will never release your optional insurance elections, private medical information, or other information considered confidential under state or federal law.)

I choose to keep my home address, personal phone numbers, social security number, emergency contact information, and information that reveals whether I have family members private. I do not want any of this information released under a Public Information Act request.

Printed name ___________________________

Signature ___________________________

Employee ID # ___________________________

Date ___________________________

09/2016

Social Security Administration

Statement Concerning Your Employment in a Job Not Covered by Social Security

Employee Name Employee ID#

Employer Name Employer ID#

Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected.

Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2013, the maximum monthly reduction in your Social Security benefit as a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, “Windfall Elimination Provision.”

Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension.

For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, “Government Pension Offset.”

For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office.

I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security Benefits.

Signature of Employee Date

Form SSA-1945 (01-2013) Destroy Prior Editions

75-6000450City of Arlington

Information about Social Security Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

New legislation [Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004] requires State and local government employers to provide a statement to employees hired January 1, 2005 or later in a job not covered under Social Security. The statement explains how a pension from that job could affect future Social Security benefits to which they may become entitled.

Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is the document that employers should use to meet the requirements of the law. The SSA-1945 explains the potential effects of two provisions in the Social Security law for workers who also receive a pension based on their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a worker’s Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a Social Security benefit received as a spouse, surviving spouse, or an ex-spouse.

Employers must:

• Give the statement to the employee prior to the start of employment; • Get the employee’s signature on the form; and • Submit a copy of the signed form to the pension paying agency.

Social Security will not be setting any additional guidelines for the use of this form.

Copies of the SSA-1945 are available online at the Social Security website, www.socialsecurity.gov/online/ssa-1945.pdf. Paper copies can be requested by email at ofsm.oswm.rqct.orders@ssa.gov or by fax at 410-965-2037. The request must include the name, complete address and telephone number of the employer. Forms will not be sent to a post office box. Also, if appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in packages of 25. Please refer to Inventory Control Number (ICN) 276950 when ordering.

Form SSA-1945 (01-2013)

06/21-TA

City of Arlington

Notice of Personnel Manual

I hereby acknowledge that the Personnel Manual containing the City’s policies is available

to me electronically through the City of Arlington Employee Intranet located on the Human

Resources Portal. I understand it is my responsibility to review the manual within my first

thirty (30) days of employment. I agree to abide by all policies and provisions of the

Manual as a condition of employment. If I have any questions about a policy, I shall contact

my supervisor or my Consultant in the Human Resources Department.

Employee Name – Printed

Employee Signature

Date

06/21-TA

City of Arlington

Wage Deduction Authorization

While employed by the City of Arlington, I may be given certain clothing, equipment, or

other city property to use when performing my job. I understand that I am required to turn

in this clothing, equipment and other city property at the end of my employment. If I do not

turn in the above, or if the property is damaged or destroyed, I agree that the replacement

value or cost of repair of the clothing, equipment, or other city property shall be deducted

from my final paycheck. I hereby authorize the City of Arlington to deduct the replacement

cost or cost of repair of clothing, equipment, or other city property not returned at the end

of my employment, from my final paycheck.

Employee Name – Printed

Employee Signature

Date

Employee ID#

City of Arlington EEO Supplemental Information

The City is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we ask that you complete this form. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse action. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. This information will not be used to make any employment decision including, but not limited to promotions, transfers or demotions.

Gender □ Female□ Male

Disability □ No□ Yes

Veteran Status □ Vietnam Era Veteran□ Special Disabled Veteran□ Other Eligible Veteran□ Not a Veteran

Race/Ethnic Origin □ American Indian or Alaska Native□ Asian□ Black or African American□ Hispanic or Latino□ Native Hawaiian or Other Pacific Islander□ Two or More Races□ White

Date

_____________________________________ Employee Name - Printed

_____________________________________ Employee Signature

12/2016