ࡱ> ` "Kbjbjss 4r ZZZZZZZ 2 2 2 2Ll2 OD3^66666> 9Dd:CCCCCCC$;EhGCQZ;66;;CZZ66 D===; Z6Z6C=;C==ZZ=6x3 ,[  2; =>D0OD=#H<#H=#HZ=<;"*;=B;V;;;;CC= ;;;OD;;;;$%d %nZZZZZZ Oklahoma District Attorneys CouncilNew Hire Information FormDistrict Number: FORMTEXT   Sex: FORMCHECKBOX M  FORMCHECKBOX FDate of Birth:  FORMTEXT      Name: FORMTEXT      Ethnicity: FORMCHECKBOX  Amer. Indian/Alaska Native FORMCHECKBOX  AsianSSN: FORMTEXT      FLSA: FORMCHECKBOX Exempt FORMCHECKBOX  Black/African Amer. FORMCHECKBOX Non-Exempt  FORMCHECKBOX  Hispanic/Latino FORMCHECKBOX  Native Hawaiian/Pacific IslanderAddress: FORMTEXT       FORMCHECKBOX  Not Specified FORMCHECKBOX  WhiteCity/State: FORMTEXT      1. Is employee a retiree from the Oklahoma Public Employees System? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, from what agency: FORMTEXT      2. Has the employee worked for the state of Oklahoma before? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, dates & agency: FORMTEXT      3. Was employee enrolled in OPERS? FORMCHECKBOX YES FORMCHECKBOX NO4. Did the employee withdraw funds from OPERS? FORMCHECKBOX YES FORMCHECKBOX NO5. Was employee enrolled in OPERS Step-Up Retirement? FORMCHECKBOX YES FORMCHECKBOX NO6. Has employee transferred from a county office that participated in OPERS? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, give agency name: FORMTEXT HJ~  " $ & H J ^ ` b l n r v ͺŲ͈ͪÿ́nŲjhL`Ujh nUh njh nUjhhXUjh nUh|MKjh|MKUjhXUj~h nUjhL`UhL`hL`h nCJaJhL`h n5CJaJhL`hL`CJaJhL`hL`5CJaJ+HJ~u?kd~$$Ifl`'( t(44 la?kd$$Ifl`'( t(44 la $$Ifa$gdL`"K( H p $$Ifa$gdV$IfAkd$$Iflp`'( t(44 lap r t a[$Ifkdb$$Iflֈ% IO`'d )$  t(44 lat v    @xkd$$Ifl\H4`', t(44 la$IfAkdj$$Iflp`'( t(44 la    < > @ B Z \ p r t ~   , . 0 H J f h j l ݾƳݣ݉~sj^ h|MKUj hXUjh|MKUjhgUhgjhgUjhXUjh nUjh nUh njh|MKUjh|MKUh|MK hL`hL`hL`jhL`Uj`h nU- N P Z Rkd$$Ifl04`', t(44 la$If  H tnnn$Ifkd $$Iflr@ x4`'8, t(44 la 2 r BRkd $$Ifl04`', t(44 la$Ifekd $$IflFx4`', t(    44 la " $ . 0 2 4 P R T x z x z | ޸ޭޢ~ h|MKhVjhXUj.hXU h|MKh|MKjhVUjChXUj hVUjhXUj hVUjhVUhV hL`h|MKjh|MKUj| h|MKUh|MK0r t v x $Ifrkdl $$Ifl4F4`'`, t(    44 lap $Ifrkd$$Ifl4F4`' , t(    44 lap z SAkd$$Ifl`'( t(44 la$Ifekd$$IflF&`': t(    44 la *,$If  $If^ gd`ekd$$IflF#`' !8 t(    44 la(.2802FHJTV\`f-./=>?䤝䤝tjhgUj,hgUjhgUjhgU h|MKhghgjhXUjhVUjhXUjrhXUjh|MKU h|MKh|MKh|MKh nhVjhVUjhVU-,.02SAkd$$Iflp`'( t(44 la$Ifekd8$$IflF l`'\ x t(    44 la0XZ$If  $If^ gd`ekd^$$IflF#`' !8 t(    44 laZ\^`SAkd4$$Iflp`'( t(44 la$Ifekd|$$IflF l`'\ x t(    44 la.CWSJ $Ifgd nAkdL$$Iflp`'( t(44 la$Ifekd$$IflF#`' !8 t(    44 la?CDRSTXZ]  -./3MNXYB B BBBBBᢚz h|MKh`h`jhXUUjhXUjhVUhVjth nUjhXUj\hXUjh|MKUjh|MKU h|MKh|MKh|MKh njDhgUjhgUhg.WXYZSJJ $Ifgd nAkdd$$Iflp`'( t(44 la$Ifekd$$IflF#`' !8 t(    44 la 2PJJJ$IfAkd|$$Iflp`'( t(44 la $Ifgd nekd$$IflF#`' !8 t(    44 la23MBB$If  $If^ gd`ekd$$IflF#`' !8 t(    44 la     7. Has employee transferred from a county office that participated in state insurance? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, give agency name: FORMTEXT      8. Are the following required forms attached?Approved Freeze Exception FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Loyalty Oath FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      I9 FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      W-4 FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Longevity Service Worksheet FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Overtime Agreement FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Drug Free Workplace Form FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Sexual Harassment Policy FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      Direct Deposit Form FORMCHECKBOX YES FORMCHECKBOX NOIf no, explain: FORMTEXT      District Attorney/Appointing AuthorityDateRevised 4-07 BBBBBBCSJJ $Ifgd nAkd $$Iflp`'( t(44 la$Ifekd $$IflF l`'\ x t(    44 laBBBBBBB CCCCLCNCbCdCfCpCrCxC|CCCDD,D.D0D8D:DVDXDZDDDDDDDDDDDDDDD EѸٴxj@'hXUjhXUj%h nUj~%hXUj%hXUh`h`5h njhVUmHnHuj"hVUjhVUhVj!hXUjD!h`Uh`jh`U.CCLCtCvC$If  $If^ gd`ekd0"$$IflF#`' !8 t(    44 lavCxCzC|CCSAkd$$$Iflp`'( t(44 la$IfekdP#$$IflF l`'\ x t(    44 laCCD8D`DDD$If  $If^ gd`?kd$$$Ifl`'( t(44 laDDDDE6E^Etg^^^X$If $Ifgd n  $If^ gd`kdj&$$Iflr\ l`'8T t(44 la EEE6E8ELENEPEZE\EfEhEEEEEEEEEEEEEEEE F F(F*F,F4F6FRFTFVF|F~FFFFFFFFFFGG G&Gj-hXUj,h nUj&,h`Uj+hXUjd*h nUj)h`Ujx)hXUjh`UmHnHuj,(h nUh`jh`Uj'h`U3^E`EfEEEEFtg^^^X$If $Ifgd n  $If^ gd`kd($$Iflr\ l`'8T t(44 laFF F4F\F|FFtg^^^X$If $Ifgd n  $If^ gd`kd*$$Iflr\ l`'8T t(44 laFFFG0GPGxGtg^^^X$If $Ifgd n  $If^ gd`kd-$$Iflr\ l`'8T t(44 la&G(G*GPGRGfGhGjGtGvGGGGGGGGGGGHH(H*H,H6H8HnHpHHHHHHHHHHHHHHIIIZI}jh`UmHnHujD3h nUj2h`UjX2hXUjhVUj 1h nUj0hXUj 0hXUjhXUj.h nUh`jh`Uj^.hXU.xGzGGGGH:Htg^^^X$If $Ifgd n  $If^ gd`kdJ/$$Iflr\ l`'8T t(44 la:H7h`Uj6hXUjh`UmHnHuj|5h nUj5h`Uh`jh`Uj4hXU$IIJ*JRJrJJtg^^^X$If $Ifgd n  $If^ gd`kd5$$Iflr\ l`'8T t(44 laJJJJJJtn-nnAkd9$$Ifl`'( t(44 la$Ifkd*8$$Iflr\ l`'8T t(44 laJJJJKKOI$IfRkd@:$$Ifl0`' t(44 la $$Ifa$gd nRkd9$$Ifl0`' t(44 laKKK K"KywAkd`;$$Ifl}`'( t(44 la$If?kd:$$Ifl`'( t(44 la21h:pL`/ =!"#$% |$$If!vh5(#v(:Vl t0(5(a|$$If!vh5(#v(:Vl t0(5(a$$If!vh5(#v(:Vlp t0(5(atDText2vDeCheck16vDCheck17DText1M/d/yyyy$$If!vh5d 5)5$555 #vd #v)#v$#v#v#v :Vl t0(5d 5)5$555 / / a$$If!vh5(#v(:Vlp t0(5(atDText3tDeCheck1$$If!vh5555,#v#v#v#v,:Vl t0(5555,/ atDeCheck2$$If!vh55,#v#v,:Vl t0(55,atD Text4tDeCheck8tDeCheck3$$If!vh555855,#v#v#v8#v#v,:Vl t0(555855,/ atDCheck9tDeCheck4$$If!vh555,#v#v#v,:Vl t0(555,atDeCheck5$$If!vh55,#v#v,:Vl t0(55,atDText5tDeCheck6$$If!vh555,#v#v#v,:Vl4 t0(+555,/ aptDCheck7$$If!vh555,#v#v#v,:Vl4 t0(+555,aptDText6$$If!vh555:#v#v#v::Vl t0(555:/ a$$If!vh5(#v(:Vl t0(5(avDCheck12vDCheck13$$If!vh5 !585#v !#v8#v:Vl t0(5 !585atDText7$$If!vh5\ 5x5 #v\ #vx#v :Vl t0(5\ 5x5 / a$$If!vh5(#v(:Vlp t0(5(avDCheck14vDCheck15$$If!vh5 !585#v !#v8#v:Vl t0(5 !585atDText8$$If!vh5\ 5x5 #v\ #vx#v :Vl t0(5\ 5x5 / a$$If!vh5(#v(:Vlp t0(5(avDCheck10vDCheck11$$If!vh5 !585#v !#v8#v:Vl t0(5 !585a$$If!vh5(#v(:Vlp t0(5(avDCheck10vDCheck11$$If!vh5 !585#v !#v8#v:Vl t0(5 !585a$$If!vh5(#v(:Vlp t0(5(avDeCheck14vDCheck15$$If!vh5 !585#v !#v8#v:Vl t0(5 !585a$$If!vh5(#v(:Vlp t0(5(avDCheck18vDeCheck19$$If!vh5 !585#v !#v8#v:Vl t0(5 !585avDText20$$If!vh5\ 5x5 #v\ #vx#v :Vl t0(5\ 5x5 / a$$If!vh5(#v(:Vlp t0(5(avDeCheck18vDCheck19$$If!vh5 !585#v !#v8#v:Vl t0(5 !585avDText10$$If!vh5\ 5x5 #v\ #vx#v :Vl t0(5\ 5x5 / a$$If!vh5(#v(:Vlp t0(5(a|$$If!vh5(#v(:Vl t0(5(avDCheck20vDCheck21vDText11$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText12$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText13$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText14$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDCheck21vDText15$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDCheck21vDText16$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText17$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText18$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 avDCheck20vDeCheck21vDText19$$If!vh55855T5 #v#v8#v#vT#v :Vl t0(55855T5 a$$If!vh5(#v(:Vl t0(5(a$$If!vh55#v#v:Vl t0(55/ / / a$$If!vh55#v#v:Vl t0(55/ a|$$If!vh5(#v(:Vl t0(5(a$$If!vh5(#v(:Vl} t0(5(a@@@ NormalCJ_HaJmH sH tH DAD Default Paragraph FontRi@R  Table Normal4 l4a (k(No Listj@j L` Table Grid7:V0HH V Balloon TextCJOJQJ^JaJ r z $%?@ABSdi '(-AG_9;<TUauvwxyVk.CWXYZ 23MabcdeFGav   "6FZ[_t*?Scwx ! 1 E F Z o '''/eQL. 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