New Client Onboarding Information Request

The following information is required to create a new hire record for your organization. This information is handled with HIPAA Compliance. Please do not print this form and attempt to hand-write the information in. Your signature will be captured electronically at the end of this form and you will receive a confirmation email upon submission. Thank you.

Today's Date

AM/PM Option

Client Legal Company Name*

DBA (If Applicable)*

Your Name*

First NameLast Name

Your Email Address*

Your personal email address, not work, is suggested for privacy.

New Hire Name*

First NameLast Name

Estimated Start Date of Employment with Lightsource Global*

Date

New Hire Personal Email*

example@example.com

New Hire Work Email*

example@example.com

Employee Status*

Full-timePart-timeTemporaryOther

If 'Temporary', please note Employment End Date:

Date

Job Title*

Annual Salary*

(In US Dollars)

Worksite Address*

Street Address

Apt, Suite, Unit, etc.

CityState

Zip CodeCountry

Job Description*

Do you offer Allowances?*

YesNo

Allowance Information

Rows	Amount	Frequency	Misc Notes
Mileage
Phone
Internet
Supplies
Other
Other

Do you offer Bonuses?*

YesNo

Bonus Information

Rows	Bonus Name	Amount	Frequency	Misc Notes
Bonus 1
Bonus 2
Bonus 3

Do you offer Commission / Incentive compensation?*

YesNo

Commission / Incentive Information

Rows	Plan Name	Amount	Frequency	Misc Notes
Plan 1
Plan 2
Plan 3

Will this Employee be eligible for Expense Reimbursements?*

YesNo

Will this Employee be eligible for Paid Time Off (PTO) / Sick / Vacation?*

YesNo

Rows	Yes, Offer	Is this time paid?	# of Days Allowed	# of Years to Carry Over	Pay Remaining Upon Term?
PTO
Sick
Vacation

Will this Employee be eligible for Benefits? (Full-time EEs Only)*

YesNo

Full-time Employees are eligible for health benefits in the US and Employers are required to contribute towards their medical premiums. Please list your contribution amount(s) below for each coverage tier. (NOTE: The minimum amount for 2022 is $337 per month and $363 for 2023, there is no maximum.)

Rows	Employee Only	Emp + Spouse	Emp + Child(ren)	Family
Monthly Contribution Amount 2022:
Monthly Contribution Amount 2023:

Will this Employee be eligible for a 401(k) / Retirement / Pension Plan?*

YesNo

Please send your new employee the following link to complete. Please feel free to click on the link to view the simple form your new hire will complete for our employment purposes.

EMPLOYEE NEW HIRE INFORMATION FORM

Thank you for choosing Lightsource Global for your EOR needs. We appreciate your partnership.

CERTIFICATION & SIGNATURE

The undersigned attests that the information contained in this document is true and correct to the best of the undersigned’s knowledge. The undersigned understands this document is not a contract for service or employment nor will it bind coverage of any kind. This information is strictly governed by HIPAA compliance rules. In the event that information has been intentionally omitted or misrepresented, the employer of record may deny or limit services. I will notify Lightsource Global of any changes to the information imparted here that occur after signing this form.

Signature*

Sign on the line above with your mouse, stylus, or finger if mobile.

Client Onboarding Information Request

CURRENT CLIENT DETAIL

NEW HIRE DETAIL