The purpose of this form is to provide a central record of the hiring, job advancement, and end of employment of any employee. This form should be completed upon the hiring of any employee and should be periodically updated as required. The following information is gathered on this form:

• Name, address, and phone of employee
• Social Security number of employee
• Date hired and starting salary
• W-4 form completion and number of dependents
• Any changes in salary
• Any changes in job position
• Date and reason for leaving employment
• Eligibility for rehiring
• Signature of employer
• Signature of employee upon separation

This form may be used in Maryland.