Global HMA — New Employee Onboarding

Required

Employee General Information

Personal details, contact information, and emergency contacts.

Personal Information

First Name *

Last Name *

Middle Name

Date of Birth *

Social Security # *

Phone Number *

Email Address *

Home Address

Street Address *

Apartment / Suite / Unit

City *

State *

ZIP Code *

County

Employment Details

Hire Date *

Position / Title *

Department

Employment Type

Direct Deposit

Your direct deposit information is encrypted in transit and stored securely. It will be used by Finance to set up your payroll.

Bank Name *

Account Type *

Routing Number *

Account Number *

Emergency Contact

Contact Name *

Relationship *

Contact Phone *

Contact Email

Required — Federal

Form W-4 — Employee's Withholding Certificate

Federal income tax withholding (IRS Form W-4, 2025 revision). Fill in all applicable steps.

Step 1 Enter Personal Information

Your name and address are pre-filled from Employee General Info. Select your filing status below.

1(a) Your first name and middle initial

—

Last name

—

1(b) Social security number

—

Address (number, street, and apartment or suite no.)

—

City or town, state, and ZIP code

—

1(c) Filing Status *

☐ Single or Married filing separately ☐ Married filing jointly or Qualifying surviving spouse ☐ Head of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Step 2 Multiple Jobs or Spouse Works Complete if applicable

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

☐ (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld.

Step 3 Claim Dependents Complete if income ≤ $200,000 (≤ $400,000 if MFJ)

Qualifying children under age 17 — multiply the number of qualifying children under age 17 by $2,000

Number of children

× $2,000 = $0

Other dependents — multiply the number of other dependents by $500

Number of other dependents

× $500 = $0

Total dependent credits entered on line 3 $0

Step 4 Other Adjustments Optional

(a)

Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.

4(a) $

(b)

Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here.

4(b) $

(c)

Extra withholding. Enter any additional tax you want withheld each pay period.

4(c) $

Exemption from Withholding

☐ I claim exemption from withholding for 2025, and I certify that I meet both of the following 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 liability. If you claim exemption, you will have no income tax withheld from your paycheck.

Required — Federal

Form I-9 — Employment Eligibility Verification

Section 1: Employee information and attestation (to be completed on or before the first day of employment).

The fields below will auto-fill from your Employee Info where possible. Please verify all information and complete additional I-9-specific fields. Section 2 (Employer Review) will be completed by HR on your start date.

Citizenship / Immigration Status

I attest, under penalty of perjury, that I am: *

A citizen of the United States A noncitizen national of the United States A lawful permanent resident (Alien Registration Number / USCIS Number) A noncitizen authorized to work (expiration date applies)

Preparer / Translator (if applicable)

A preparer and/or translator assisted the employee in completing Section 1.

Upload Identification Documents

Upload photos or scans of your I-9 supporting documents. You may provide one document from List A (which proves both identity and work authorization), OR one from List B + one from List C. Accepted file types: JPG, PNG, PDF (max 10 MB each).

List A documents establish both identity and employment authorization. Examples: U.S. Passport or Passport Card, Permanent Resident Card (Form I-551), Employment Authorization Document (Form I-766), Foreign Passport with Form I-94.

📷

Drag & drop your List A document here

or click to browse — JPG, PNG, or PDF up to 10 MB

List B documents establish identity only. Examples: Driver's License, State ID Card, School ID with photo, Voter Registration Card, U.S. Military Card. Must be combined with a List C document.

📷

Drag & drop your List B document here

or click to browse — JPG, PNG, or PDF up to 10 MB

List C documents establish employment authorization only. Examples: Social Security Card (unrestricted), Birth Certificate, U.S. Citizen ID Card (Form I-197), Employment Authorization Document issued by DHS. Must be combined with a List B document.

📷

Drag & drop your List C document here

or click to browse — JPG, PNG, or PDF up to 10 MB

Reminder: You must also present the original documents to HR in person on your first day. Uploaded copies are for pre-processing only and do not replace the in-person verification requirement.

Required — State

PA Certificate of Residency (CLGS-32-6)

Required for Pennsylvania local earned income tax withholding.

This certificate is required so your employer can withhold the correct local earned income tax. Under Pennsylvania Act 32, your resident tax rate is determined by the municipality and school district where you live.

Resident Location

Municipality (City/Borough/Township) *

School District *

County *

PA PSD Code (6-digit) *

Total Resident EIT Rate (%)

You can look up your PSD code and EIT rate at munstatspa.dced.state.pa.us using your home address. If you're unsure, HR can assist you.

Effective Date of Residency

Phone Number (daytime)

Lancaster County

Lancaster County Certificate of Residence

Local tax withholding certificate for Lancaster County residents.

If you reside within Lancaster County, this certificate certifies your municipality and school district for local tax purposes. This is filed with the Lancaster County Tax Collection Bureau.

Do you reside in Lancaster County? *

Yes No

Municipality (Borough/Township) *

School District *

Move-in Date (if recent)

Previous Municipality (if recently moved)

Required

Workers' Compensation Acknowledgement

Acknowledgement of your rights and duties under the Pennsylvania Workers' Compensation Act.

Employee Rights & Duties Under the Workers' Compensation Act

In case of a work-related injury or illness, you may be entitled to benefits under the Pennsylvania Workers' Compensation Act.

Your rights include:

• The right to receive medical treatment for work-related injuries or illnesses.

• The right to receive wage-loss compensation if you are unable to work due to a work-related injury or illness.

• The right to choose your own health care provider after the first 90 days of treatment (or immediately if your employer has not posted a list of designated providers).

Your duties include:

• Report any work-related injury or illness to your supervisor immediately.

• Seek treatment from a provider on your employer's list of designated health care providers for the first 90 days (if a list has been posted).

• Cooperate with your employer and the workers' compensation insurance carrier in the investigation and processing of your claim.

• Return to work when your health care provider releases you to do so.

Penalties: Failure to report a work-related injury may result in a delay or denial of benefits. Fraud is a crime and may result in criminal prosecution, including fines and imprisonment.

I acknowledge that I have received and read the notice of my rights and duties under the Pennsylvania Workers' Compensation Act. I understand these rights and duties. *

Employee Signature (type full name) *

Date *

Required

HR Manual Receipt & Acknowledgement

Acknowledgement of receipt and review of the Global HMA Employee Handbook / HR Manual.

Employee Handbook / HR Manual Acknowledgement

I acknowledge that I have received a copy of the Global HMA Employee Handbook (HR Manual). I understand that it is my responsibility to read and familiarize myself with the policies, rules, and procedures described in the manual.

I understand that:

• The handbook is not a contract of employment and does not guarantee employment for any specific duration.

• My employment with Global HMA is at-will, meaning either I or Global HMA may terminate the employment relationship at any time, with or without cause, and with or without notice.

• Global HMA reserves the right to modify, revoke, suspend, terminate, or change any or all policies, procedures, and benefits, in whole or in part, at any time, with or without prior notice.

• If I have any questions regarding the content or interpretation of the handbook, I will bring them to the attention of Human Resources.

I acknowledge that I have received a copy of the Global HMA Employee Handbook and understand it is my responsibility to read and comply with its contents. *

Employee Signature (type full name) *

Date *

Required

Employee Confidentiality & Non-Solicitation Agreement

Protection of company confidential information and client relationships.

Confidentiality & Non-Solicitation Agreement

As an employee of Global HMA, I understand that I may have access to confidential and proprietary information during the course of my employment.

Confidential Information includes, but is not limited to: client lists, client data, business strategies, financial information, marketing plans, proprietary methods and processes, employee information, and any other information not generally known to the public.

I agree to the following:

• Non-Disclosure: I will not disclose, publish, or otherwise disseminate any Confidential Information to any third party without prior written consent from an authorized representative of Global HMA, except as required in the normal course of my employment.

• Return of Materials: Upon termination of my employment (voluntary or involuntary), I will return all documents, files, records, and other materials containing Confidential Information to Global HMA.

• Non-Solicitation: During my employment and for a period of twelve (12) months following the termination of my employment, I will not directly or indirectly solicit, divert, or take away any clients, customers, or accounts of Global HMA that I had contact with or knowledge of during my employment.

• Non-Recruitment: During my employment and for a period of twelve (12) months following termination, I will not recruit or solicit any employee of Global HMA to leave the company.

I understand that a breach of this agreement may result in disciplinary action up to and including termination, as well as legal action for damages and/or injunctive relief.

I have read, understand, and agree to the terms of the Confidentiality and Non-Solicitation Agreement above. I understand that this agreement remains in effect during and after my employment with Global HMA. *

Employee Signature (type full name) *

Date *

Final Step

Review & Submit

Please review your information below. Click any section header to go back and edit.

✓

Onboarding Submitted Successfully!

Your information has been securely transmitted to HR & Finance. No further action is needed from you.

What happens next:
• Finance has received an email notification with your submission details
• Your direct deposit will be set up before your first paycheck
• W-4 withholding takes effect on your first paycheck
• Bring original I-9 identification documents on your first day

Questions?
Contact HR at hr@globalhma.com if you need to make any corrections.