Employee Signature. Date: Employer Signature: Date:
Employee Signature. Date: AFSCME Local Representative Signature:
Employee Signature. Date: Employer Signature: Date: By: Title: . (Print Name) AIG Retirement Services represents AIG Member Companies - The Variable Annuity Life Insurance Company (VALIC) and its subsidiaries VALIC Financial Advisors, Inc. (VFA) and VALIC Retirement Services Company (VRSCO). All are members of American International Group, INC. (AIG). VL 19573 VER 5/2019 Original - Employer, Copy - Employee
Examples of Employee Signature in a sentence
Employee Name: (Please print) Employee Signature: Job Title: Employee ID: Telephone No: Employee Address: Work Location: Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete.
Employee Signature: Date: Specific information regarding tuition remission including eligibility, enrollment guidelines, and taxation of benefits, is available in the Employee Policy Manual at xxxxx://xxx.xxxxxx.xxx/department/hr/about.
More Definitions of Employee Signature
Employee Signature. Date: Employer Signature: Date: By: Title: . (Print Name) VALIC represents The Variable Annuity Life Insurance Company and its subsidiaries, VALIC Financial Advisors, Inc . and VALIC Retirement Services. VL 23823 VER 12/2015 Original - Employer, Copy - Employee
Employee Signature. Signature Date: Employee Printed Full Name: Date of Hire: _______ FOR ADMINISTRATIVE/EMPLOYER USE ONLY Reporting Section 3 Resident Status: The purpose of the HUD/CDBG Section 3 program is to provide employment, training, and contracting opportunities to individuals with low or very low income levels. Each new full-time employee or trainee (working full-time in a permanent, temporary or seasonal position) working on this CDBG-funded project is requested to self-certify their annual family income at the time of hire. The employer is to determine from this information whether the employee qualifies as a Section 3 Resident (as defined in 24 CFR 135). This form is to be completed and submitted to the designated grant administrator or prime contractor for required reporting. Is this new full-time employee a Section 3 Resident (i.e., having an annual family income “At or Below” the HUD income limit for their family size as listed on the certification form in the year prior to their Date of Hire and living in the same county where the CDBG project is located)? Yes No Was this new Employee hired as a result of participating on the CDBG project? Yes No Does the employer qualify as a Section 3 Business concern? Yes No *An employer working on this project qualifies as a Section 3 Business Concern if they meet any of the following criteria: 51% or more of the business is owned and controlled by Section 3 Residents, or A business whose permanent, full-time employees include persons, at least 30% of whom are currently Section 3 Residents, or within three years from their date of first employment with the business concern were Section 3 Residents, or A business that provides evidence of a commitment to subcontract in excess of 25% of the dollar award of all subcontracts to be awarded to business concerns that meet the qualifications set forth in the first & second bullet points (above) in this definition of a “Section 3 Business Concern.” EMPLOYERS & CDBG GRANTEES MUST RETAIN THIS FORM IN THEIR SECTION 3 COMPLIANCE PROJECT FILES.
Employee Signature. Date: Employer’s Approval: Date:
Employee Signature. Date: Supervisor Signature: Date: Vice President Approval: Date:
Employee Signature. Printed name: Date: Health and Prescription Drug Coverage The State of Maryland will offer subsidized health and prescription drug benefit coverage for contractual employees (and their dependents) who have a current employment contract and are scheduled to regularly work 30 or more hours a week (or an average 130 hours per month or faculty teaching 9 credits or more a semester). The employee will be responsible for paying 25% of the premiums for medical and prescription coverage for themselves and any eligible dependents enrolled. The State of Maryland will subsidize the remaining 75% of the benefit premiums for these benefits. Monthly direct pay billing from DBM will reflect the remaining 25%. Contingent II employees may be eligible for additional assistance from their department. Other Benefit Coverage Contractual Contingent I and Contingent II employees who have a current employment contract and work 30 or more hours a week (or an average of 130 hours per month or faculty teaching 9 credits or more a semester) may also elect to enroll in dental coverage, life insurance and accidental death and dismemberment insurance, but will be responsible to pay the full premium for these benefits. Contingent II employees may be eligible for additional assistance for dental coverage from their department.
Employee Signature. Date: Department Head Signature: Date: Personnel Officer Signature: Date: 1/94 APPENDIX G GENESEE COUNTY DENTAL BENEFITS WAIVER Name: Title: Please check one of the following: Please check one of the following: Management DSA AFSCME-392 Other I do not wish to participate in the Genesee County dental benefits program. By not participating, I wish to exercise my option for the dental buy back offered by the County. I do not wish to participate in the Genesee County dental benefits program, and waive my option for the dental buy back offered by the County. By signing this waiver of dental benefits coverage, I indicate that I do not wish to participate in the dental benefits program with Genesee County. I understand that if, at some future date, I decide to rejoin/join the dental benefits plan with the County, I will be subject to the same limitations and provisions that apply to new members who enroll in the dental insurance plan.
Employee Signature. Date: Department Head Signature: Date: