Locally Funded Employment Request Form

Church or school treasurers should use this form to request the hiring or report the termination of a locally funded employee.

Note Regarding New Hires

In addition to completing the Locally Funded Employment Form, you will need to submit an I-9, as well as State and Federal W-4 forms.

These forms are available through our HR and Treasury department, please contact Mary Freeman at 515.223.1197 x 2116 or admin@imsda.org for assistance.

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Treasurer - Locally Funded Employment Form

New Hire or Termination? *

Employee Name *

First

Employee Last Name *

Last

Employee Email

Employee Phone Number

Position/Title *

Church/School/Facility *

Board Approved Date *

Hourly Wage *

Average Number of Hours Per Week *

Termination Date *

Reason for Termination *

Official Start Date

Form Submitted by *

Your First and Last Name

Your Email Address *

Your Phone Number *

xxx-xxx-xxxx

Signature *

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