New Hire Paperwork

New Hire Paperwork Instructions

Congratulations on your new position with Penn State Hershey Medical Center!  We are excited that you have decided to join our family of amazing employees.  Prior to the first day of orientation, you are required to complete new hire paperwork.  We have provided the forms here so that you can complete them prior to your scheduled orientation.  If at any point you have questions or concerns, please do  not hesitate to contact your HR Recruiter or our HR Service Center at 717-531-8440.


You must have Adobe Reader to use these forms.  Adobe Reader is free software that lets users view, fill, and print filled in Adobe PDF files on all major computer platforms.  Some of the forms are provided as "fillable" PDF files for your convenience.  You must have at least Adobe Acrobat Reader 4.0 installed on your computer to view, complete, and print fillable forms.  Get Adobe Reader here:

Instructions for "Fillable" PDF files: Acrobat Reader does not allow you to save what you key into the form, nor can you email the completed form - you should plan on completing the form and immediately printing the completed form. It may be easier to print and complete all of the forms by hand.  You may do what works best for you.

FORM 1: New Hire Checklist

Details: This is an overview of all the forms that follow below, including important points to remember and what documents you are required to bring on your first day.  Please pay close attention to this form as it will serve as a guide to assist you with the completion of your paperwork. 

FORM 2: Local Earned Income Tax Residency Certification Form

Details: This form is used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes. Please complete all highlighted fields; however, please leave the Employer FEIN and PSD Fields blank (our Payroll Department will provide this information).

FORM 3: W-4 Form

Details: This form allows us to withhold the correct federal income tax from your pay.  Please complete the bottom half of this form.

FORM 4: Form I-9

Details:  All U.S. Employers must complete and retain a Form I-9 for each individual they hire for employment in the United States - Original documents are required - no photocopies.  This includes citizens and non-citizens.  On the form, the employer must examine the employment eligibility and identity document(s) an employee presents to determine whether the document(s) reasonably appear to be genuine and relate to the individual.  Employers must also record the document information on the Form I-9.  The list of acceptable forms of documentation are attached along with the form itself.

FORM 5: Direct Deposit Form

Details:  For your convenience, Penn State Hershey Medical Center allows employees to authorize automatic payroll and/or expense reimbursement to be deposited into their checking accounts at almost any bank or financial institution in the United States.  Please be sure to complete all highlighted sections of this form.  You may designate separate accounts for payroll and/or expense reimbursements.  Instructions on how to have your paycheck directly deposited into your account are included on this form.

FORMS 6, 7 & 8: Self-Identification Forms: (To Be Completed By New Hires Only)
Self-Identification Form
VEVRAA Self-Identification Form
Disability Self-Identification Form

Details: Penn State Hershey Medical Center is an equal opportunity/affirmative action employer.  As a federal contractor, we are required to keep records on the race, sex, ethnicity, disability and veteran status of our employees and to file periodic reports with the government.  This information will be kept confidential. Please complete all 3 forms.

FORM 9: Confidentiality Agreement

Details: Penn State Hershey Medical Center and the College of Medicine (PSHMC/COM) are critically dependent upon information and information systems to fulfill the organization's missions.  Patients, students, business associates and workforce members expect that reasonable and prudent measures will be taken to safeguard information entrusted to PSHMC/COM.  You will be asked to certify your understanding of this expectation on this form.  Please be sure to complete all highlighted sections.

FORM 10: Worker's Compensation Form

Details: If you are injured at work or suffer an occupational illness, you have certain legal rights and duties under Section 306 (f.1) (I)(i) of the Worker's Compensation Act regarding your medical treatment.  This document details those rights and duties.  You will need to certify that you have been informed and understand these rights and duties at the bottom of this form.

FORM 11: Intellectual Property Agreement (IPA) Form

Details: This form provides detailed information about the terms of the agreement.  You will need to print, sign and date this form.  An HR professional will provide the Witness signature.  Please bring all 5 pages of this form with you to orientation.

FORM 12: Employee Health Department - Infectious Disease Summary

Details: This provides instructions on completing the Employee Health Record.  Please complete all highlighted sections.  You will need to bring this form to orientation, along with any childhood/adult immunization records.

FORM 13: Campus Map

Details:  We have included a copy of the Campus Map to assist you with finding your orientation location.

**Important: The following new hires will also need to complete an IT Account Request form:

  • Anesthesia Tech
  • Echo Peds Tech
  • ED Tech
  • EKG Tech
  • Endoscopy Tech
  • Graduate Nurse / Nurse Extern
  • Hemodialysis Tech
  • LPN (including Outpatient)
  • Medical Assistant
  • Nurse Anesthetist
  • Nurse Practitioner
  • Operating Room Aide
  • Patient Care Assistant
  • Patient Care Secretary
  • Patient Safety Companion
  • RNs
  • Social Worker  
  • Surgical Tech
  • Veurophysiology Tech

Please print and complete the following form in addition to the paperwork outlined above: