Revised:  2012  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New  Employee    

Welcome  Orientation  Packet  

 -­‐PLEASE  PRINT  PRIOR  TO  BEGINNING  THE  WEBINAR-­‐

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Welcome  to  the  Children’s  Museum  of  Pittsburgh!  

Prior  to  logging  into  the  Welcome  Online  Orientation,  please  print  this  packet.  To  complete  the  enclosed  paper  forms,  follow  the  instructions  provided  during  your  online  orientation  session.  

If  you  experience  any  difficulties  accessing  the  online  orientation,  please  call  us  or  email  Cathy  Cicco,  Manager  of  Human  Resources,  for  assistance.  (ccicco@pittsburghkids.org;  412.322.5058  x290)  

 

Welcome  Orientation  Process  (approximately  one  hour):  

1. Receive  your  welcome  email  from  the  Children’s  Museum  of  Pittsburgh  which  includes:  

a. Job  Description  

b. Access  information  for  the  online  webinar  

c. Link  to  the  downloadable  orientation  packet,  supplemental  materials,  and  policy  manual  

2. Print  the  forms  in  the  Orientation  Packet  

3. Log  into  and  complete  the  Welcome  Orientation  webinar  using  the  information  from  your  email  

a. To  complete  the  webinar,  you  MUST  have  the  following  

i. Most  up-­‐to-­‐date  version  of  Adobe  Reader  (this  is  free  and  you  will  be  prompted  to  update  your  computer’s  software  automatically  if  necessary)  

ii. Internet  access  

iii. Sound  and  audio  capability  

4. Complete  all  required  forms  included  in  the  webinar  

5. Bring  the  following  with  you  to  your  first  day  of  work:  signed  job  description,  packet  of  downloaded  forms,  proper  identification  (as  notes  on  the  I-­‐9),  money  order(s),  and  voided  check  or  direct  deposit  statement  (full  check-­‐list  found  on  page  4  of  this  Welcome  Packet)  

 

 

Enclosures:  Part-­‐time  Employee  Orientation  Check-­‐list,  Form  I-­‐9,  Form  W-­‐4,  City  of  Pittsburgh  LST  Exemption,  Local  Earned  Income  Tax  Certificate,  PA  Criminal  Record  Check,  PA  Child  Abuse  History  Clearance,  Consent/Release  of  Information  Authorization,  Direct  Deposit,  Worker’s  Compensation

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Children’s  Museum  of  Pittsburgh  

New  Employee  Orientation  Checklist  

As  you  complete  the  orientation,  please  check  –off  your  progress  below.  You  will  turn  in  this  checklist  to  the  Museum’s  Human  Resource’s  Department  on  your  first  day  of  work.  

o Welcome  and  Introduction  to  Museum  

o Completed  “New  Hire  Information”  form  

o Policy  Overview  

o Completed  Code  Adam  quiz  

o Compensation  &  Benefits  Overview  

o Completed  “Transportation  Benefit  Plan  Enrollment”  

o Completion  of  Paper  Hiring  Forms  (see  box  to  right)  

o I  have  completed  the  Welcome  Orientation  Online  

 

HR  Manual  Acceptance  

o I  have  received  a  copy  of  the  HR  Manual  outlining  the  responsibilities  of  an  employee  and/or  volunteer  and  the  responsibilities  of  the  organization.  I  have  read  the  information  contained  in  the  Children's  Museum  of  Pittsburgh's  HR  Manual.  If  I  have  any  questions,  I  should  contact  the  Business  Office,  HR  representative  or  my  supervisor.  

o I  understand  that  the  information  contained  in  the  Children's  Museum's  HR  Manual  represents  guidelines  only  and  that  the  Children's  Museum  reserves  the  right  to  modify  this  Manual  or  amend  or  terminate  any  policies,  procedures,  or  employee  benefit  programs  at  any  time.  I  understand  that  the  Children's  Museum  will  apply  such  policies  and  practices  to  particular  situations  as  it  deems  to  be  in  its  best  interest.  

o I  understand  that  this  Manual  is  not  a  contract  of  employment  between  me  and  the  Children's  Museum  and  that  I  should  not  view  it  as  such.  

o I  understand  that  I  am  an  "at-­‐will"  employee  of  the  Children's  Museum  and  accordingly  I  have  the  right  to  terminate  my  employment  at  any  time  for  any  reason  and  the  Children's  Museum  retains  a  similar  right  to  terminate  my  employment.  

 

Employee  signature:             Date:        

 

 

 FOR  OFFICE  USE    

Witness:          

All  relevant  paperwork  has  been  completed:     Yes       No  

 

ü Form  I-­‐9,  Employment  Eligibility  Verification  

ü Form  W-­‐4  

ü City  of  Pittsburgh,  Local  Service  Tax  –  Exemption  Certificate  

ü Local  Earned  Income  Tax  Certificate  

ü Pennsylvania  State  Police,  Request  for  Criminal  Record  Check  

ü Pennsylvania  Child  Abuse  History  Clearance  

ü Consent/Release  of  Information  Authorization  Form  

ü Employee  Direct  Deposit  Enrollment  Form  

ü Worker’s  Compensation,  Employee  Acknowledgement  of  Rights  &  Responsibilities  

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REMINDERS    

Materials  to  bring  on  your  first  day:  

o Signed  Orientation  Check-­‐list    and  HR  Manual  Acceptance  (page  3  of  this  packet)  

o Signed  copy  of  your  job  description  (emailed  to  you  by  Cathy  Cicco,ccicco@pittsburghkids.org;  412.322.5058  x290)  

o Appropriate  form(s)  of  identification  (see  the  enclosed  “I-­‐9  Employment  Verification,  List  of  Acceptable  Documents”)  

o Originals  only,  do  not  bring  photo  copies.  

o One  $10  money  orders  (used  to  process  your  child  abuse  verification)  

o Signed  and  made  out  to:  Department  of  Public  Welfare  

o A  second  $10  money  order  is  needed  IF  you  chose  to  do  the  paper  Criminal  Background  Check  (instead  of  online).  This  should  be  signed  and  made  out  to:  Commonwealth  of  Pennsylvania  

o Voided  check  or  direct  deposit  statement  from  your  financial  institution  (to  process  your  direct  deposit)  

o All  completed  paper  forms:  

o Form  I-­‐9,  Employment  Eligibility  Verification  

o Form  W-­‐4  

o City  of  Pittsburgh,  Local  Service  Tax  –  Exemption  Certificate  (if  applicable)  

§ Also  include  all  required  documentation  as  listed  on  the  LST  form  

o Local  Earned  Income  Tax  Certificate  

o Pennsylvania  State  Police,  Request  for  Criminal  Record  Check  (online  submission  preferred)  

o Pennsylvania  Child  Abuse  History  Clearance  

o Consent/Release  of  Information  Authorization  Form  

o Employee  Direct  Deposit  Enrollment  Form  

o Worker’s  Compensation,  Employee  Acknowledgement  of  Rights  &  Responsibilities  

Please  keep  the  following  supplemental  materials  for  your  records:  

ü Worker’s  Compensation  Physician  Panel:  Physicians  who  are  approved  to  provide  care  if  you  are  injured  on  the  job  

ü The  current  year  pay  schedule  

ü Parking  information  

ü A  copy  of  your  job  description  

ü Summary  of  benefits  

ü Access  information  for  the  HR  Manual  

LOCAL EARNED INCOME TAXRESIDENCY CERTIFICATION FORM

DCED-CLGS-06 (1-11) COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENTGOVERNOR’S CENTER FOR LOCAL GOVERMENT SERVICES

EMPLOYEE INFORMATION - RESIDENCE LOCATION

TO  EMPLOYERS/TAXPAYERS:This form is to be used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes.This form must be utilized by employers when a new employee is hired or when a current employee notifies employer of a name and/or address change.

NAME (Last, FIrst, Middle Initial) SOCIAL SECURITY NUMBER

FIRST LINE OF ADDRESS (If PO Box, please include actual street address)

SECOND LINE OF ADDRESS

CITY STATE ZIP CODE DAYTIME PHONE NUMBER

CERTIFICATIONSIGNATURE OF EMPLOYEE DATE

PHONE NUMBER EMAIL ADDRESS

MUNICIPALITY (City, Borough, Township)

COUNTY PSD CODE TOTAL RESIDENT EIT RATE

EMPLOYER INFORMATION - EMPLOYMENT LOCATIONEMPLOYER NAME (Use Federal ID Name) EMPLOYER FEIN

FIRST LINE OF ADDRESS (IIf PO Box, please include actual street address)

SECOND LINE OF ADDRESS

CITY STATE ZIP CODE PHONE NUMBER

MUNICIPALITY (City, Borough, Township)

COUNTY PSD CODE MUNICIPAL NON-RESIDENT EIT RATE

For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES and EIT (Earned Income Tax) RATES,please refer to the Pennsylvania Department of Community & Economic Development website:

www.newPA.comSelect Get Local Gov Support, >Municipal Statistics

Children's Museum of Pittsburgh

1%

251379704

10 Chidren's Way

Pittsburgh PA 15212 412-332-5058

Pittsburgh

Allegheny 7 0 0 1 0 2

CONSENT/RELEASE OF INFORMATION AUTHORIZATION FORM FOR THE PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE

I, (Applicant’s Name), hereby authorize the Department of Public Welfare, ChildLine to release my Pennsylvania Child Abuse History Clearance information directly to CHILDREN’S MUSEUM_OF PITTSBURGH. I understand that this information is confidential in nature pursuant to §6340 (relating to information in confidential reports) of the Child Protective Services Law (CPSL) (23 Pa.C.S Chapter 63) and will not otherwise be released by the CHILDREN’S MUSEUM without my express authorization or pursuant to authorization by Title 55 of the Pennsylvania Code. I understand that the aforementioned information will not be released directly to me ______________________________ (Applicant’s Name) as stated in the Pennsylvania Child Abuse History Clearance application. I understand that I will not receive a copy of my Pennsylvania Child Abuse History Clearance directly from ChildLine; however, I will receive a copy of my Pennsylvania Child Abuse History Clearance from __CHILDREN’S MUSEUM OF PITTSBURGH. I have read this Consent/Release of Information Authorization form and fully understand and agree to its content. I further understand and agree to all information and ramifications of the Pennsylvania Child Abuse History Clearance application as it otherwise relates to this consent. _______________ _________________________________ Date Applicant’s Signature Children’s Museum of Pittsburgh Attention: HR 10 Children’s Way Pittsburgh, PA 15212

Direct Deposit Agreement Form

Employee Name: _________________________________ Effective Date: ___________________

I wish to Set up Direct Deposit Change my Direct Deposit Cancel my Direct Deposit

Account Information

I wish to deposit to Checking Savings Money Card or Other: ___________

Name of Financial Institution:

Routing Number: Account Number:

Please only select one of the following: I wish to deposit: Set Amount: $________ or Percentage _____% or Total Pay (Net Amount)

You may select multiple institutions/methods of deposit. If more than two are selected, please attach additional forms.

I wish to deposit to Checking Savings Money Card or Other: ___________

Name of Financial Institution:

Routing Number: Account Number:

I wish to deposit: Set Amount: $________ or Percentage _____% or Total Pay (Net Amount)

A VOIDED CHECK (not a starter check) OR DIRECT DEPOSIT STATEMENT FROM YOUR BANK

MUST BE ATTACHED TO THIS FORM TO PROCESS YOUR REQUEST.

**You must notify payroll immediately in writing if you change or close your bank account**

Authorization Agreement

I hereby authorize Children’s Museum of Pittsburgh to initiate automatic deposits to my account at the financial institution named above. I also authorize Children’s Museum to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold Children’s Museum responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until Children’s Museum receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

Employee Signature: _______________________________ Date: __________________________

5/24/2011

WORKERS’ COMPENSATION

EMPLOYEE ACKNOWLEDGEMENT OF RIGHTS & RESPONSIBILITIES

Employer: Children’s Museum of Pittsburgh Policy: HCPA001363

In Pennsylvania, the workers' compensation law provides wage loss and medical benefits toemployees who cannot work, or who need medical care, because of a work-related injury.

Benefits are required to be paid by your employer when self-insured, or through insuranceprovided by your employer. Your employer is required to post the name of the companyresponsible for paying workers' compensation benefits at its primary place of business and atits sites of employment in a prominent and easily accessible place, including, without limitation,areas used for the treatment of injured employees or for the administration of first aid.

You should report immediately any injury or work-related illness to your employer.

Your benefits could be delayed or denied if you do not notify your employer immediately.

If your claim is denied by your employer, you have the right to request a hearing before aworkers' compensation judge.

The Bureau of Workers' Compensation cannot provide legal advice. However, you may contactthe Bureau of Workers' Compensation for additional general information at:

Bureau of Workers' Compensation1171 South Cameron Street, Room 103Harrisburg, Pennsylvania 17104-2501Telephone number within Pennsylvania (800) 482-2383Telephone number outside of this Commonwealth (717) 772-4447TTY (800) 362-4228 (for hearing and speech impaired only)www.state.pa.us - PA Keyword: workers comp.

I also acknowledge that I have been presented with this written notice setting forth my rightsand duties under Section 306(f.1)(1)(I) of the Pennsylvania Workers’ Compensation Act. Myrights and duties include the following:

1. I recognize and agree that my employer has posted a list of at least six (6) health careproviders, at least three (3) of which are physicians and no more than four (4) of which arecoordinated care organizations (CCO). I further agree that my employer has provided thename, address, telephone number, and area of medical specialty of each designatedprovider on the list.

2. I have the duty to obtain treatment for work-related illnesses from one or more of thedesignated health care providers listed below for ninety (90) days from the date of first visitto a designated provider.

5/24/2011

3. As long as treatment is obtained from a designated provider during the ninety (90) dayperiod, all reasonable medical supplies and treatment related to the injury will be paid bymy employer.

4. I have the right to switch from one designated health care provider on the list to anotherduring the ninety (90) day period and my employer must pay for this treatment.

5. If I am referred by a designated provider to a non-designated provider, my employer shallprovide for the treatment rendered by the referral provider.

6. I have the right to seek emergency medical treatment from any provider, but I understandthat subsequent non-emergency treatment must be rendered by a designated provider forthe remainder of the ninety (90) day period.

7. I have the right during the ninety (90) day period to seek medical treatment from a non-designated provider, but I understand my employer is not responsible to pay for theseservices.

8. After the expiration of the ninety (90) day period, I have the right to seek treatment from anyhealth care provider, and my employer must pay for such treatment if it is reasonable andnecessary.

9. If I treat with a non-designated health care provider after the expiration of the ninety (90)day period, I understand that I must provide my employer notice within five (5) days of myfirst treatment with the non-designated provider. If I fail to do so, my employer may not beresponsible to pay for treatment rendered by the non-designated provider prior tonotification; and,

10. If the designated provider recommends invasive surgery, I am entitled to receive anadditional opinion from any health care provider of my choice. If the additional opiniondiffers from that of the designated provider, I am entitled to select which course oftreatment to follow. However, if I choose to follow the recommendation of my health careprovider (the additional opinion), the procedure shall be performed by one or more of thedesignated health care providers for a period of ninety (90) days from the date of the visit tomy health care provider (date of examination of the additional opinion).

I, ___________________________________________________________, employee of

Children’s Museum of Pittsburgh, hereby certify that I was provided with the above statement

and attached Provider Panel.

________________________________________________ ____________________Employee Signature Date

________________________________________________ ____________________Witness Signature Date

CITY OF PITTSBURGH 2013 LOCAL SERVICE TAX – EXEMPTION CERTIFICATE

A copy of this application for exemption from the Local Services Tax (LST), and all necessary supporting documents, must be completed and presented to your employer and to the political subdivision levying the Local Services Tax for the municipality or school district in which you are primarily employed.

This application for exemption from the Local Services Tax must be signed, dated, and given to each employer.

No exemption will be approved until proper documentation has been received.

PRINT NAME: ______________________________ SOCIAL SECURITY #: ____________________ ADDRESS: ________________________________ PHONE #: ____________________________ CITY – STATE – ZIP: ________________________________________________________________

REASON FOR EXEMPTION 1. _____ MULTIPLE EMPLOYERS: Attach a copy of a current pay statement from your principal employer

that shows the name of the employer, the length of the payroll period and the amount of Local Services Tax withheld. List all employers on the reverse side of this form. You must notify your other employers of a change in principal place of employment within two weeks of the change.

2. _____EXPECTED TOTAL EARNED INCOME AND NET PROFITS FROM ALL SOURCES WITHIN THE CITY OF PITTSBURGH WILL BE LESS THAN $12,000: Attach copies of your last pay statements from all employers or copies of your W-2’s from all employers for the prior year. Also submit copies to your employer(s).

If you are SELF-EMPLOYED, attach a copy of your PA Schedule C, F, or RK-1 for the prior year.

3. _____ACTIVE DUTY MILITARY EXEMPTION: Attach a copy of your orders directing you to active duty status. Annual training is not eligible for exemption. You are required to advise your employer and tax office when you are discharged from active duty status.

4. _____MILITARY DISABILITY EXEMPTION: Attach a copy of your discharge orders and a statement

from the United States Veterans Administrator documenting your disability. Only 100% permanent disabilities are

recognized for this exemption. EMPLOYER: Once you receive this Exemption Certificate, you shall not withhold the Local Services Tax for the portion of the calendar year for which this certificate applies, unless you are otherwise notified or instructed by the taxpayer or tax collector to withhold the tax. Employer must retain Exemption Certificate. Tax Office: LST Exemption Certificate, City of Pittsburgh, Department of Finance, Address: 414 Grant Street Room 212 City, State & Zip: Pittsburgh PA 15219 The municipality is required by law to exempt from the LST employees whose earned income from all sources (employers and self-employment) in their municipality is less than $12,000. SIGNATURE:_________________________________________________ DATE: __________________________ For additional information go to www.city.pittsburgh.pa.us/finance or call 412-255-2504.

EMPLOYMENT INFORMATION: List all places of employment for the applicable tax year. Please list your PRIMARY EMPLOYER under #1 and your secondary employers under the other columns. If self-employed, write “SELF” under employer name column. 1. PRIMARY EMPLOYER 2. 3.

Employer Name

Address

Address 2

City, State & Zip

Municipality

Employer Phone

Start Date

End Date

Status FT or PT

Gross Earnings

4. 5. 6.

Employer Name

Address

Address 2

City, State & Zip

Municipality

Employer Phone

Start Date

End Date

Status FT or PT

Gross Earnings