Name

Employee ID

Department

Date of Hire

Health Insurance

•  Enrollment Completed

•  Beneficiary Designation Form Submitted

•  Copy of Plan Document Received

Retirement Plan

•  Enrollment Completed

•  Beneficiary Designation Form Submitted

•  Employee Contribution Percentage Set

Dental Insurance

•  Enrollment Completed

•  Beneficiary Designation Form Submitted

•  Copy of Plan Document Received

Paid Time Off

•  PTO Policy Received and Understood

•  Current PTO Balance Acknowledged

Vision Insurance

•  Enrollment Completed

•  Beneficiary Designation Form Submitted

•  Copy of Plan Document Received

Employee Assistance Program

•  Information Packet Received

•  Contact Information for Assistance Acquired

Life Insurance

•  Enrollment Completed

•  Beneficiary Designation Form Submitted

•  Copy of Plan Document Received

Professional Development and Training

•  Information on Programs Received

•  Applications for Relevant Programs Submitted (if applicable)