Human Resources Request

Employee Number *

Name *

First

Last

Choose a Department *

Phone Number where Human Resources can contact you if more information is needed

Email (if you have one)

Request Type *

Please Choose your preferred contact method

Multiple Choice *

Text Message
Voice Message

Phone *

Enter your new address here

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please describe what Uniform pieces you need, the reason for the request and what sizes are needed

Please hit Submit request and Human Resources will reach out to you to have the appropriate W4 forms filled out

Uniform Request Description

Please enter the start and end dates for the period you are requesting pay stub(s) for.

Please Note: There is a $10 fee for each request.

Period Start Date

Period End Date

Please choose the reason you need a new badge

Name badge Reasons

Damage/Worn
Lost

There is a $25 fee to replace your name badge if it is lost

Please Choose how you would like to have this fee applied

If your badge is worn or damaged, you must turn in your old badge to HR to avoid a $25 replacement badge fee

Payment Method for Badge

Cash
Payroll Deduction

Please submit this form and Human Resources will reach out you to complete the required paperwork.

If you would like to schedule an appointment with Human Resources, click submit below and a member of Human Resources will contact you with available times

Please attach a photograph of the front and back of your vaccination card. You may also upload a electronic copy in PDF format

Human Resources will maintain this record and inform your manager of vaccination status.

FIle Upload

Click or drag files to this area to upload. You can upload up to 2 files.

Let us know what's on your mind! Use the box below to communicate directly with an HR staff member.

Type your message here

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.