On Boarding Form - Slap Burger Bar

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New Employee Notice

Step 1 of 7

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Branch*
Employment Date*
MM slash DD slash YYYY
Employment Type*
- Full-Time
- Part-Time
Employee Information
Name*
First Last
I live at:*
Street Address City State ZIP Code
Home Phone
Mobile/Other Phone*
Email*
EEOC*
- A
- AA
- H
- I
- W
A=Asian, AA=African American, H=Hispanic, I=Indian, W=White
Marital Status*
- Single
- Married
- Divorced
- Widowed
DOB*
MM slash DD slash YYYY
Social Security #*
Military*
- Yes
- No
SPOUSE INFORMATION
Name
First Last
Employer
Mobile/Other Phone
Work Phone

POSITION INFORMATION
Position Title
- Kitchen
- LN Kitchen
- Shift Leader
- LN Keyholder
- Bar Tender
Hidden
Position Title
Schedule*
- Day Shift
- Afternoon Shift
- Weekends
Target Work Week (# hours)*

EMERGENCY CONTACT INFORMATION
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*

EMPLOYEE ACKNOWLEDGEMENT OF WORKERS COMPENSATION NETWORK
LIBERTY HEALTHCARE NETWORK
Workers Compensation Network Acknowledgement
I have received information that tells me how to get health care under workers’ compensation insurance. If I am hurt on the job and live in the service area described in this information, I understand that:

1. I must choose a treating doctor from the list of doctors in the network, Or, I may ask my HMO primary care physician to agree to serve as my treating doctor.
2. I must go to my treating doctor for all health care for my injury. If I need a specialist, my treating doctor will refer me. If I need emergency care, I may go anywhere.
3. The insurance carrier will pay the treating doctor and other network providers.
4. I might have to pay the bill if I get health cared from someone other than a network doctor without network approval.
Signature*
Date*
MM slash DD slash YYYY
Printed Name*
Address*
Street Address City State ZIP Code
Name of Network: Liberty Health Care Network

DIRECT DEPOSIT AUTHORIZATION
To sign up for Direct Deposit, please complete the authorization below by following these instructions:
1. Check the box indicating where you want your pay deposited--to your checking account or savings account.
2. Fill in your account information.
3. Electronically Sign and date the form.
4. Provide a voided check or savings deposit slip for verification of your account information.
On payday, you will receive an earnings statement showing your gross pay, tax and other deductions, and the net amount of your deposit. Your pay will be in your account and available to you. I authorize Speedie Pies or Slap Burger Bar and the financial institution named below to automatically deposit my net pay to my account (this includes my authorization for Speedie Pies or Slap Burger Bar to reverse any entries made in error). This authority will remain in effect until I give written notice to my payroll department.
Account Type*
- Checking
- Savings
Account Number*
Bank Routing Number*
Name of Financial Institution*
Location (Branch)
Date*
MM slash DD slash YYYY
Signature*

REQUIRED FORMS TO COMPLETE
Please click on the link below to complete the required IRS Form W-4. Once completed, please PRINT the documents out to be signed.

IRS Form W-4

Please click on the link below to complete the required I-9 form. Once completed, please PRINT the documents out to be signed.

Employment Eligibility Letter Form I-9

FINAL SUBMISSION
Please click on 'Submit form' below to complete the Speedie Pies | Slap Burger Bar Electronic Onboarding Packet.

Contact Us

105 Avenue A
Denton, TX 76201
940-985-5252
slap@slapbb.com

New Employee On Boarding Form

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Location

105 Avenue A
Denton, TX 76201

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