Filling out hiring paperwork on DocuSign

• Fill out all required fields
• Read each text box carefully to ensure you type in the correct information
• Use your Full LEGAL name (no nicknames), as it appears on your Legal Documents
• Please manually type in information. Pre-filling or auto-filling may cause the form to fill incorrectly. 

Section One - Personal Information

• Last name (Legal Name)
• First Name (Legal Name - no nick names)
• Middle Initial
• Address
• City
• State
• Zip Code
• Date of Birth - mm/dd/yyyy
• U.S. Social Security Number - Please DOUBLE CHECK this to ensure you typed it corrected
• Employee's E-mail Address
• Employee's Telephone Number

Section Two - Citizen/Residency Status

Select the correct option based on your status:

• A citizen of the United States
• A noncitizen national of the United States
• A lawful permanent resident
• An alien authorized to work

Section Three - Signature

• Please review all the above information, verifying you have correctly entered all required fields and select "Sign" and enter a digital signature. 

Section Four - Preparer and/or Translator certification (check one)

• Select the check box 'I did not use a preparer or translator"  

Step 1: Enter Personal Information

Section (a) - please fill in the appropriate information requested for each box.  Be sure to double check your data entry for accuracy.

• First name and Middle Initial
• Last Name
• Address
• City
• State
• Zip Code

Section (b) 

• Social Security Number 

Section (c) 

• Select ONE box that best describes your Federal tax filing status
  • Single or Married filing jointly
  • Married filing jointly
  • Head of Household (see instructions before selecting this box)

Step 2: Multiple Jobs or Spouse Works

• If you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works, you may choose to check box (c) if there are two jobs total for your household and if those jobs are similar in pay.  Otherwise, you may elect to leave this box unchecked.  
• Note: Reliant cannot advise you on this selection so please make sure you read the instructions carefully and seek outside professional tax assistance if needed. 

Step 3: Claim Dependents:

• Multiply the Number of qualifying children under age 17 by $2,000 
  • See example above, 1 child = $2,000
• Multiply the number of other dependents by $500
  • See example, enter $500 for a spouse that you claim (spouse doesn't work outside of the home) or for an older dependent like a special needs adult living in your household
• Add the amounts from both boxes above and enter the total on line 3

Step 4: Other Adjustments

• 4(a) Other Income (not from jobs)

  • This box may be used to indicate additional withholding you want withheld annually to cover other sources of income on which you will pay taxes, such as retirement income or investment income.

  • See example above, if I expect to have $1200 in Capital Gains on which I'll owe taxes for the year, I'd enter that amount in this 4(a) box.

• 4(b) Deductions

  •  This box may be used to indicate deductions that you anticipate in excess of the standard deduction amount.

  • See example above, if I expect to have itemized deductions that exceed the standard deduction amount by $5,000, I would enter $5,000 in this 4(b) box.

  • Note: If you anticipate taking the standard deduction when filing your taxes, leave this box blank.

•  4(c)Extra Withholding  

  • This box may be used to enter additional tax you want withheld each pay period 
  • Note: Reliant pays monthly so these extra withholding taxes would be withheld every month, in addition to your normal taxes for that paycheck.
  • Commissioned/Ordained Ministers may choose to utilize this box to indicate an amount they want withheld as extra Federal taxes that they will use to cover their 15.3% SECA (Social Security/Medicare) obligation, since Reliant does not withhold FICA taxes for these employees.  See Paying SECA Taxes. 

Requesting EXEMPTION from Federal Tax Withholding

• To claim exemption from federal tax withholding due to Foreign Earned Income Exclusion or other qualified reasons, the W-4 instructions say write “Exempt” in the space below Step 4(c). Then, ensure you have completed Steps 1a, 1b, and 5. There is an "Optional" Box on the Docusign form for you to indicate this EXEMPT selection.
• See example above, please Type in "EXEMPT" to elect this tax setting.
• Do not complete Steps 2-4 on the form if claiming exemption.

Step 5: Sign Here

• See example above, by selecting "sign" and entering a digital signature this will complete your acknowledgement/submission of this form.

Section I. Missionary Information

Please fill in the appropriate information requested for each box.  Be sure to double check your data entry for accuracy.

• Missionary Full Legal Name (as appears on your bank account) in format: First name Last name 
• MTD 4-digit Fund#
• Street Address
• City
• State
• Zip Code
• Birthdate
• Social Security Number
• Phone Number

Section II. Your Account Information

Option A: Deposit my entire NET payroll in this "primary" account

• Select this option if you only have one bank account into which you want your full paycheck deposited.
• Enter the 9 digit ACH routing number for the bank account that will either be the "Primary" or Remainder" bank account, based on what you selected for Option A& B above.
  • Note: The routing number is the first set of numbers printed on the bottom of your checks, on the left side. 
  • This information is also available online on your bank's website or through the bank's phone app

• Enter the Account Number for the bank account that will either be the "Primary" or Remainder" bank account, based on per what you selected for Option A& B above.
  • Note: The account number is usually between eight and 12 digits. This number is listed at the bottom of a printed check, after the routing number. 
  • This information is also available online on your bank's website or through the bank's phone app
• Indicate if this bank account is classified as a Checking or Savings account
  • This information is available online on your bank's website or through the bank's phone app

Option B: Deposit the remaining payroll amount (after other deposits listed on this form) in this Primary bank account

• Select this option if you would like to divide your payroll deposit up to be deposited into multiple bank accounts.
• This option is commonly used if an employee prefers to deposit a specific amount from each paycheck into another Checking/ Savings account, and then the remainder into their Checking account.  

Primary Routing & Account Information

• Enter the 9 digit ACH routing number for the bank account that will either be the "Primary" or Remainder" bank account, based on what you selected for Option A& B above.
  • Note: The routing number is the first set of numbers printed on the bottom of your checks, on the left side. 
  • This information is also available online on your bank's website or through the bank's phone app
• Enter the Account Number for the bank account that will either be the "Primary" or Remainder" bank account, based on per what you selected for Option A& B above.
  • Note: The account number is usually between eight and 12 digits. This number is listed at the bottom of a printed check, after the routing number. 
  • This information is also available online on your bank's website or through the bank's phone app
• Indicate if this bank account is classified as a Checking or Savings account
  • This information is available online on your bank's website or through the bank's phone app

Additional Payroll Account Routing & Account Information

• See the example above, if an employee wanted to deposit $500 into an additional Checking account, they would indicate the deposit amount in this section. 
• The remaining portion of their paycheck, after this designated $500 deposit, would then be deposited into the "Remainder" bank account listed under Section 11. Option B above

Section IV. Additional Bank Info P.2 (for a Third Payroll Deposit Bank Account or Special Reimbursement Bank Account)

• If you selected Option B. under Section II. Account Information and have an additional third account you'd like to divide your paycheck deposit into, scroll to P.2 of the Direct Deposit form and enter the additional bank account in Section IV. using the provided cells.
• See the example above, if an employee wanted to deposit $100 into a Savings account, they would indicate the deposit amount in this IV Section. 
• The remaining portion of their paycheck, after the designated deposits for additional bank accounts #2 and #3 would then be deposited into the "Remainder" bank account listed under Section 11. Option B above

Section V. - For Reimbursements ONLY

• See example above, if an employee wants all their Reimbursements from Reliant to be deposited into a different bank account other than their "Primary" or "Remainder" bank account specified under Section II. they can complete this section of the Direct Deposit form specifying their Routing and Account number for the bank account they designate for their reimbursements to be deposited.  

Signature

• See example above, by selecting "sign" and entering a digital signature this will complete your submission of this form.

Signature

• Please read through the entire text 
• By selecting "sign" and entering a digital signature this will complete your acknowledgement/submission of this form.

• Your name will be auto populated 
• Enter in your 4-Digit Fund Number (if you do not know it, reach out to your liaison)
• The form will prompt you to click "sign" & it will sign your electronic signature
• The date will auto-populate  

Signature

• Please read the entire text 
• By selecting "sign" and entering a digital signature along with typing in your 4-digit MTD FD#  this will complete your acknowledgement/submission of this form.

Section A: Complete with general information about yourself in the red boxes.

Section B:

1. If you are enrolling in coverage, you will select " yes " then select who you are enrolling in coverage and what plan you would like. 

1. If you are waiving coverage because you are covered under another insurance policy (see Insurance Waiver Options ),you will select "no" and it will take you to Section D

Section C : If are enrolling in coverage, complete this box with who will be on your plan. Then it will take you to Section E to sign and submit.

Section D : If you are waiving medical coverage 

1. Select the waivable reason from the drop down menu below.
   1. Other Individual Coverage 
   2. Other Group Coverage

1. Select who you are waiving coverage for
   

Section E : Sign the form.

Enrolling in/Declining Voluntary Dental Coverage: 

Select from the Drop Down menu options: 

• "no deny dental coverage"
• "yes enroll in dental coverage"
• The drop down box will remain blank but your selection will allow you to skip completion of the form (if declining coverage) or additional red text boxes will appear (if enrolling in coverage)

Enrolling in Dental Coverage

• Select the plan you want to enroll in: 
  • DENTAL LOW (Tier One "Low" Plan, Dental 1250) 
  • DENTAL HIGH (Tier Two "High" Plan, Dental 1500)
• Marital Status
• Social Security Number
• Employee's Last Name, First, MI (Middle Initial)
• Date of Birth
• Male/Female
• Occupation: Use Missionary or Pastor etc.
• Hours worked per week
• Are your earnings paid Hourly/Salaried
• Street Address
• City
• State
• Zip
• Question: Are you covered under another Dental Insurance Plan? Yes/No
• Question: Dependents (Are they covered under another Dental Insurance Plan?) Yes/No
• Dependent Coverage information: Fill in Required fields for all dependents being covered on this dental plan
  • Full Legal Name (Last, First, MI)
  • Select: ADD
  • Relationship: Type Spouse or Child
  • Sex: M/F
  • Date of Birth
  • Social Security Number

Signature

• By selecting "sign" and entering a digital signature this will complete your submission of this form.

Top Section: Enter your Information

• Insured name: (Your Name) First Name Last Name
• Social Security Number: Your Social Security Number 

Middle Section: Enter the Information of your Beneficiaries

Primary Beneficiary

• Full Name and Address: Enter the Full Name (First Name Last name) and Address of the person you are selecting as your Primary Beneficiary
• Percentage: Enter 100% (*see details above if you'd like to name more than one Primary Beneficiary)
• Date of birth: Enter your Primary Beneficiary's date of birth
• Relationship: Enter your Primary Beneficiary's relationship to you - Ex. Spouse, Child, Parent, Friend Etc.
• Social Security Number: Enter your Primary Beneficiary's Social Security Number 

Contingent Beneficiary - This is the alternate beneficiary, used only if the Primary Beneficiary is unable to claim the life insurance payout

• Full Name and Address: Enter the Full Name (First Name Last name) and Address of the person you are selecting as your Contingent Beneficiary
• Percentage: Enter 100% (*see details above if you'd like to name more than one Contingent Beneficiary)
• Date of birth: Enter your Contingent Beneficiary's date of birth
• Relationship: Enter your Contingent Beneficiary's relationship to you - Ex. Spouse, Child, Parent, Friend Etc.
• Social Security Number: Enter your Contingent Beneficiary's Social Security Number 

Signature

• By selecting "sign" and entering a digital signature this will complete your submission of this form.

• Indicate who you would like Reliant to contact in case of an emergency
• Select if you would to allow us to release any information related to your Reliant employment. See Release of Personal Information for more details.
• Add any additional individuals

Emergency Contact

Please fill in the required fields:

• Full name: First Name Last Name
• Relationship: Spouse, Parent, Sibling, Friend, Etc
• Address:
• City:
• State:
• Zip Code:
• Email Address:
• Phone Number:

Release of Personal Information

Declining To Submit a Release of Personal Information Designee: 

• If you do NOT want to designate someone to have access to these types of information on your behalf, skip these options and leave the check box and drop downs blank.

Electing to authorize your Emergency Contact as a Release of Personal Information Designee: 

• Check the box "I grant authorization to Reliant Mission to release the following information to this third-party designee"
• Select what information you would like to release. Check either "All Information" or which individual types of information you would like to release. 
• Select from the Drop Down menu Options:
  • "I have completed releasing my information" 
  • "I would like to release information to additional individuals"

Electing to authorize an Additional Contact(s) as Release of Personal Information Designee(s): 

Please fill in the required fields:

• Full name: First Name Last Name
• Relationship: Spouse, Parent, Sibling, Friend, Etc
• Address:
• City:
• State:
• Zip Code:
• Email Address:
• Phone Number:

• Check the box "I grant authorization to Reliant Mission to release the following information to this third-party designee"
• Select what information you would like to release. Check either "All Information" or which individual types of information you would like to release. 
• Select from the Drop Down menu Options:
  • "I have completed releasing my information" 
  • "I would like to release information to additional individuals"

Signature

• By selecting "sign" and entering a digital signature this will complete your submission of this form.

Hire Date Information

You may be asked about your expected hire or any expected changes before your hire. Please answer according to your knowledge when filling out the form. This is not used to process your hire, but to inform us on if we may need additional forms. You may receive further forms or follow up from Employment Services. Please be sure to check your Reliant email for that communication. 

Auto Insurance

Our insurance carriers require us to verify that associates and employees are covered by auto insurance. See the available options for submitting that information.

Employment Location

Based on where you will be working, you may need to pay state or local taxes. Based on your response, you may receive further forms or follow up from Employment Services. Please be sure to check your Reliant email for that communication. 

Commissioning or Ordination

If you are ordained or commissioned, please see: Working with Reliant as a Commissioned or Ordained Minister for more details on what steps need to be taken should you choose claim your religious worker status with Reliant. you may choose to start that process with your initial paperwork, or wait until closer to your hire. 

Cafeteria Form

If you would like to select Vision Coverage, Child-Care Benefit deductions, or HSA payroll deductions, please fill out the Cafeteria Plan Enrollment Form.