Quick Hire

Quick Hire Form

*You will need account information to set up Direct Deposit for your pay.
Contact Information
Name*

First NameLast Name
Personal Email Address
Phone Number*
Please enter a valid phone number.
Phone Number Type*

CellHomeWork
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Personal Data
Driver's License or Personal ID Card
State
ID Number
MonthDayYear
Expiration Date
Social Security Number*
Date of Birth*

MonthDayYear

Direct Deposit Information
I would like my paycheck paid by*

Direct deposit to 1 bank accountSplit direct deposit to 2 bank accounts
Amount Paid to Primary Bank Account
Direct Deposit Account 1
Direct Deposit Account 2

Certification
What is your highest level EMS Certification?*

I do not have an EMS Certification.EMREMTAEMTParamedic
EMS ID*
Registry Number*
Expiration Date*

MonthDayYear
Date

Emergency Contact
Contact's Name

First NameLast Name
Relation
Contact's Phone Number
Please enter a valid phone number.
Contact's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Company
Select all that apply.

I completed the online W-4.I completed the online I-9.I uploaded my I-9 personal identification documents.I have not submitted any employment documents.
Company Identifier*

EBS030521 - Elite Business Strategies, LLCHES030521 - Healthcare Equity SolutionsLM3030521 - LM3 SolutionsTSD030521 - The Savvy Dimension, LLC

Consent and Verification
My electronic signature verifies that all personal information entered on this form is true and correct to the best of my abilities. *

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