Student New Hire Checklist UMBC Personnel Action Request Form (Hire, Rehire, Reinstatement,and Transfer) W-4 (and supporting documents if employee is non-resident alien) Completed I-9 and Copies of Supporting Documents Signed Substance Abuse Acknowledgement of Receipt form Work Permit (Students age 17 and .shtml Direct Deposit form (Not Required for New Hire)Department is required to provide to the employee an email/copy of:LINK: r/new-hires/o I-9 Instructionso Substance Abuse Policyo Tax Exempt Refiling Memo Social Security verification is not required but please ensure you verify the number is accurate onthe New Hire PAR form.Revised 1/30/13

To:Employees Claiming Exempt for State and/or FederalFrom: Lisa Drouillard, Payroll DirectorDate: January 20, 2017Subject: Annual Requirement to file a W-4 when claiming exemptEffective immediately, employees who claimed exempt for Federal and/or State income taxwithholding must file a paper version of the W-4 annually if they wish to remain exempt in thenext calendar year. Employees claiming exempt cannot use the Payroll Online Service Center(POSC). If an employee is claiming exempt because they live in PA or VA, they DO NOT need tore-file.IRS regulations require Central Payroll Bureau (CPB) to revert back to the “max tax” forindividuals currently claiming exempt but do not re-file. Employees changing from exempt totaxable also need to complete a new W-4 so they will be taxed according to their designationand not automatically “max taxed”.IMPORTANT LINKS:2017 W-4 form: roll Website for Employees: Account Information: -directdeposit/

UMBCPersonnel Action Request FormHire, Rehire, and TransferAn Honors University in MarylandUniversity of Maryland Baltimore County1000 Hilltop CircleBaltimore, MD 21250Instructions: Please complete this form and attach all supportingDocuments. Forward to Human Resources – Payroll. HELP TEXT AAPPEARS IN THE BOTTOM LEFT CORNER OF THE SCREEN1 Action*3 Supporting Documents2 Reason*W-4I-9 & Supporting DocumentsRetirement Selection FormSocial Security VerificationNon-resident Alien/Required Docs On File7 Prior Agency Code (USM Transfer)Permanent ResidentFaculty Supplemental Data FormSelect 1 Option/NASubstance AbuseCHIPRA Acknowledgement FormSelect 1 Option4 Effective Date*5 Employee ID (If Known)6 Prior USM/State Service DatePERSONAL DATA (complete all fields; for one-time pay appointments complete only those fields with an asterisk (*)8 First Name*9 Middle Name/Initial10 Last Name*11 SuffixSelect 1 Option12 Home Address*13 County of Residence*Select 1 Option14 City*15 Postal (Zip)*16 State*17 Preferred Email18a Home Phone #Other:18b Campus Phone #19 Gender*20 Highest Education Level21 Marital Status22 Military Status23 US Citizen*Select 1 OptionSelect 1 OptionSelect 1 OptionSelect 1 OptionSelect 1 Option24 Date of Birth*25 Birth Country*26 Social Security #*27 Visa Type*Academic Organization: FACULTY; class schedulingUMBCSelect 1 Option28a Ethnicity*28b Race*Select 1 OptionAmerican Indian/Alaska NativeBlack or African AmericanAsianNative Hawaiian/Other Pacific IslanderWhiteJOB DATA (complete all fields; for one-time pay appointments complete only those fields with an asterisk (*)29 Position Number*30 Department ID*31 Department Name*32 Job Code/Title*33 Standard HRS / FTE34 End Date*/Term29a30a31a32a33a34a29b30b31b32b35 Employee Class*33b36 Payment Method*34b37 Bi-weekly/Hourly Rate38 Annual SalarySelect 1 OptionSelect 1 OptionEMERGENCY CONTACT INFORMATION39 Name40 Relationship41 AddressSame Address as Employee42 PhoneSame Phone as EmployeeComments:THE APPROVALS SECTION MUST BE COMPLETEDCOMPLETED BYName (Please Type or Print)SignatureDatePhone NumberE-mail AddressSIGNATURE AUTHORITYName (Please type or Print)SignatureDatePhone NumberE-mail AddressHR APPROVAL/VERIFICATION (HR USE )Pay GroupFICA StatusSALCNTHRLSubjectRetirement SystemEligibleNot EligibleTransfers OnlyORP - TIAAPay FrequencyW9MTHU26UM22HRLExemptORP - FidelityEmpls Pension 7%CommentsTeacher's Pension 7%LEOPSEmpl’s Ret, 5%Emp’s Retire 7%Payroll Staff InitialsDateCommentsData Entry Staff InitialsDateEmployee ID /RcdTeacher’s Ret, 5%Teacher’s Ret, 7%CommentsRevised: 01/2015

Employee Withholding Allowance CertificateFOR MARYLANDMAAND STATES TE GOVERNMGRNMENTT EMPMPLOYEESS ONLY20172007Form W-4-4DepartmentDepatment of the TreasueasuryInternal RevenueR venue ServiceviceFormorm MW 507ComptrollerComptoller of MarylandMa landPleaselease completec mplete form in blackbla k Whetherhether youou area e entitled to claimlaim a certaince tain number of allowancesall wances or exemptionexempti n fromf om withholding issubject to revivieww by the IRS.IYourour employerempl er may be requiequireded to send a copy of this form to the IRS.ISection 1 - EmployeeEmpl yee InformationInfo mationoll Systemstem (check one)PayrollRGCTame of EmployingEmpl ing AgencyAgenName UMocial Secuecurityy NumberumberSocialAgencyy NumberAgenumberEmployeeEmplyee Nameame360231Addddressess Continued (apartment(apa tment number,numbe if any)Home Addddressess (number and streetst eet or ruralural route)oute)StateCityZip Code(Nonresidents enter Maryland County orBaltimore City where you are employed)County of Residence (required)Section 2 - Federalederal Withholdingithholding Form W-4-4The federal worksheetwo ksheet is available online at http://www.irs.ghttp://ww ocialsecu y cardsecurityard,3SingleingleMar iedMarriedMar ied, but withhold at higher SingleMarriedingle Ratecheckk here.chehere Youou mustust callall 1-800-772-1213 for a replacement card.ard.Noteote. If marriedmar ied, but legallylegal y separated,separated or spouse is a nonresidentnon esident alien,alien checheckk the “Singlingle” bbox.5 Totalotal number of allowancesall wances youou area e claiminglaiming (from(f om page 1 or page 2 of the federal worksheet)wo ksheet)6 Additionaldditional amount,amount if any,an youou want withheld fromf om each paychepa heckk .56 7 I claimlaim exemption fromf om withholding for 2017,2017 and I certifyce tify that I meet both of the followingfoll wing conditions for exemption. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and This year I expect a refund of all federal income tax withheld because I expect to have no tax liabilityIf youou meet both conditionsconditi ns, writeite “ExempExempt” hehere.e.7Sectionection 3 - MarylandMa land Withholdingithholding Formm MW 507The MarylandMa land worksheetwo ksheet is available online at forms/MW507.pdf forms/MW507.pdfSingleMarried (surviving spouse or unmarried Head of Household) RateMarried, but withhold at Single Rate1. Totalotal number of exemptions youou area e claiminglaiming not to exceed line f in Personal Exemption Worksheet on page 2. . .1.2. Additionaldditional withholding per pay periodpe iod under agreementag eement with employer.empl yer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.3. I claimlaim exemption frofromm withholding becausebe ause I do not expect to owewe MarylandMa land See instructions and check boxes that apply.a. Lastast year I did not owewe any MarylandMa land income tax and had a rightight to a full refundefund of all income tax withheld andb. This year I do not expect to owewe any MarylandMa land income tax and expect to have the rightight to a full refundefund of all income tax withheld.withheld(This(This includesin ludes seasonal and student employeesempl ees whose annual income willwi l be belowbel w the minimummini um filing requiequirements)ements).If both a and b apply,app enter year applicableappli able (year effective) Enter “EXEMPTPT” hehere.e. . . . . . . . . . . . . .3.4. I claimlaim exemption frofromm withholding becausebe ause I am domiciled in the followingfoll wing state.stateVirginiairginiaI furtherfu ther certifyce tify that I do not maintain a place of abode in MarylandMa land as describeddesc ibed in the instructiinst uctions.ns.Enter “EXEMPT” heheree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.5. I claim exemption from Maryland state withholding because I am domiciled in the Commonwealth of Pennsylvaniaand I do not maintain a place of abode in Maryland as described in the instructions on Form MW507.Enter “EXEMPT” here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. I claim exemption from Maryland local tax because I live in a local Pennysylvania jurisdiction within York orAdams counties. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7. I claim exemption from Maryland local tax because I live in a local Pennsylvania jurisdiction that does not imposean earnings or income tax on Maryland residents. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . .8. I certify that I am a legal resident of the state of and am not subject to Maryland withholding becausel meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military SpousesResidency Relief Act. Enter “EXEMPT” here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - Employee SignaturenatureSectionUnder penalties of perjury,perju I declade laree that I have examined this certifice tificateate and to the best of my knowledgekn wledge and belief,belie it is true,tcorrectcorect, and complete.complete Ifurtherfuther certifyce tify that I am entitled to the number of withholding allowancesall wances claimedlaimed on line 1 above,abor if claiminglaiming exemption fromfr om withholding,withholdin that I amentitled to claimlaim the exempt status on which everver line(s) I completed.EmployeEmplyee’ss signaturesi nature(Formorm is not valid unless youou sign it.)Daytime phone number (in case CPB needs to contact you regarding your W4)Employer’s name and address (Employer: Complete name, address & EIN only if sending to IRS)DateFederal Employer identification number (EIN)Central Payroll BureauP.O. Box 2396Annapolis, MD 21404ImportantImpotant: The informainfo mationion youou suppsupplyy mustust be complete.complete This formfo m willwi l replace in total anya y certifice ificateate youou previouspr viouslyy submitted.submit ted.Webeb Siteite -

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 08/31/2019 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,during completion of this form. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify whichdocument(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employan individual because the documentation presented has a future expiration date may also constitute illegal discrimination.Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterthan the first day of employment, but not before accepting a job offer.)Last Name (Family Name)Apt. NumberAddress (Street Number and Name)Date of Birth (mm/dd/yyyy)Middle InitialFirst Name (Given Name)U.S. Social Security Number-Other Last Names Used (if any)StateCity or TownZIP CodeEmployee's Telephone NumberEmployee's E-mail Address-I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident(Alien Registration Number/USCIS Number):4. An alien authorized to workuntil (expiration date, if applicable, mm/dd/yyyy):Some aliens may write "N/A" in the expiration date field. (See instructions)QR Code - Section 1Do Not Write In This SpaceAliens authorized to work must provide only one of the following document numbers to complete Form I-9:An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.1. Alien Registration Number/USCIS Number:OR2. Form I-94 Admission Number:OR3. Foreign Passport Number:Country of Issuance:Signature of EmployeeToday's Date (mm/dd/yyyy)Preparer and/or Translator Certification (check one):I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct.Today's Date (mm/dd/yyyy)Signature of Preparer or TranslatorLast Name (Family Name)Address (Street Number and Name)First Name (Given Name)City or TownStateZIP CodeEmployer Completes Next PageForm I-9 07/17/17 NPage 1 of 3

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 08/31/2019Section 2. Employer or Authorized Representative Review and Verification(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. Youmust physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Listsof Acceptable Documents.")Employee Info from Section 1Last Name (Family Name)List AFirst Name (Given Name)ORList BM.I.ANDList CIdentityIdentity and Employment AuthorizationCitizenship/Immigration StatusEmployment AuthorizationDocument TitleDocument TitleDocument TitleIssuing AuthorityIssuing AuthorityIssuing AuthorityDocument NumberDocument NumberDocument NumberExpiration Date (if any)(mm/dd/yyyy)Expiration Date (if any)(mm/dd/yyyy)Expiration Date (if any)(mm/dd/yyyy)Document TitleQR Code - Sections 2 & 3Do Not Write In This SpaceAdditional InformationIssuing AuthorityDocument NumberExpiration Date (if any)(mm/dd/yyyy)Document TitleIssuing AuthorityDocument NumberExpiration Date (if any)(mm/dd/yyyy)Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge theemployee is authorized to work in the United States.The employee's first day of employment (mm/dd/yyyy):Signature of Employer or Authorized RepresentativeLast Name of Employer or Authorized Representative(See instructions for exemptions)Today's Date (mm/dd/yyyy)Title of Employer or Authorized RepresentativeFirst Name of Employer or Authorized RepresentativeEmployer's Business or Organization Address (Street Number and Name)City or TownEmployer's Business or Organization NameStateZIP CodeSection 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)A. New Name (if applicable)Last Name (Family Name)B. Date of Rehire (if applicable)First Name (Given Name)Middle InitialDate (mm/dd/yyyy)C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishescontinuing employment authorization in the space provided below.Document TitleDocument NumberExpiration Date (if any) (mm/dd/yyyy)I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and ifthe employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.Signature of Employer or Authorized RepresentativeForm I-9 07/17/17 NToday's Date (mm/dd/yyyy)Name of Employer or Authorized RepresentativePage 2 of 3

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIREDEmployees may present one selection from List Aor a combination of one selection from List B and one selection from List C.LIST ADocuments that EstablishBoth Identity andEmployment Authorization1. U.S. Passport or U.S. Passport Card2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machinereadable immigrant visa4. Employment Authorization Documentthat contains a photograph (FormI-766)5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:a. Foreign passport; andb. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;and(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.6. Passport from the Federated States ofMicronesia (FSM) or the Republic ofthe Marshall Islands (RMI) with FormI-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMILIST BLIST CDocuments that EstablishEmployment AuthorizationDocuments that EstablishIdentityORAND1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address3. School ID card with a photograph4. Voter's registration card5. U.S. Military card or draft record6. Military dependent's ID card7. U.S. Coast Guard Merchant MarinerCard8. Native American tribal document9. Driver's license issued by a Canadiangovernment authorityFor persons under age 18 who areunable to present a documentlisted above:1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:(1) NOT VALID FOR EMPLOYMENT(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal4. Native American tribal document5. U.S. Citizen ID Card (Form I-197)6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)7. Employment authorizationdocument issued by theDepartment of Homeland Security10. School record or report card11. Clinic, doctor, or hospital record12. Day-care or nursery school recordExamples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).Refer to the instructions for more information about acceptable receipts.Form I-9 07/17/17 NPage 3 of 3

STATE OF MARYLANDSUBSTANCE ABUSE POLICYACKNOWLEDGEMENT OF RECEIPTAs an employee of the University of Maryland Baltimore County, I,, hereby certify that I have received a copy ofthe State of Maryland Substance Abuse Policy as well as the UMBC Abuse Policyand Campus Plan which concern the maintenance of a drug-free work place andcampus. I realize that the unlawful manufacture, distribution, dispensation,possession of use of a controlled dangerous substance is prohibited on the State’sowned or utilized premises and violation of either of these policies can subject meto discipline up to and including termination. As a condition of employment, Imust abide by the terms of this policy and will notify my supervisor of anycriminal drug conviction no later than five (5) days after such conviction. I furtherrealize that if I am directly supported by a Federal grant or contract, Federal lawmandates that the employer communicate the conviction to that Federal agency,and I hereby waive any and all claims that may arise for conveying thatinformation to that Federal agency.Employee’s SignatureDateSupervisor’s/Witness SignatureDate

STATE OF MARYLANDPAYROLL DIRECT DEPOSIT AUTHORIZATIONRegularPayroll System (Check one)ContractEmployee’s Name (please print)Social Security Number-University of Maryland-Agency CodeAgency Name (please print)I authorize the State of Maryland Central Payroll Bureau to take the following action with my net salary:(Check One)1. Initiate deposit directly to my checking/savings account(Will take at least two pay periods to allow for pre-note process.)2. Change account type(checking/savings account), and/or bank routing number to which my net salaryis deposited (cancel of old account will occur within 21 days for receipt of CPB; you will receive apayroll check until the new account is established)Do not close account until payroll check is issued.3. Discontinue direct deposit into my checking/savings and issue a payroll check instead.Do not close account until payroll check is issued.CPB Use OnlyEffective PPE:Processed by:Bank Name:(Omit if action 3 is checked)Account Type: (Must Check One)If not marked this form will be returnedCheckingSavingsBank NumberChecking/Savings Account NumberIAT requirementVerify carefully. For checking, copy directly from your personal check. Do notinclude your check number. Do not use your deposit slip number.Check box if your full net pay is subsequently transferred to a foreign bank.I authorize the State of Maryland to deposit my net salary to the bank and account named above. This authorization is to remain in force until the Stateof Maryland receives written notification from me of its termination in time and manner that allows the State and the bank a reasonable opportunity toact upon it. In the event that the State of Maryland notifies the bank that funds to which I am not entitled have been deposited to my account in error, Iauthorize and direct the bank to return said funds to the State as soon as possible. If the funds erroneously deposited to my account have been drawnfrom that account so that return of those funds by the bank to the State is not possible, I authorize the State to recover those funds by setting off theamount erroneously paid me from any future payments from the State until the amount of the erroneous deposit has been recovered, in full.DateEmployee signatureDaytime phone numberInstructions: Only one account is permitted for direct deposit. You can choose either checking or savings not both. Type or print only (except signature). Use black ink only. Complete all blocked areas in the top part of form except for the section “CPB use only.” Read authorization and sign the completed form. Only original forms will be accepted. Unsigned or Incomplete forms will be returned. Deposit amount will be full net amount of pay into either your checking/savings account. If changing your account type, bank and or account number, you will receive a payroll check until new direct deposit becomes effective. Do not send a voided blank check.CPB/c/dd/0059/9-2017 Send completed form to Central Payroll Bureau, P.O. Box 2396, Annapolis, MD 21404. Phone 410-260-7401.

1000 Hilltop Circle Baltimore, MD 21250 Instructions: Please complete this form and attach all supporting Documents. Forward to Human Resources - Payroll. HELP TEXT A APPEARS IN THE BOTTOM LEFT CORNER OF THE SCREEN 1 Action*