Part-Time Benefited Employee New Hire Paperwork

The following is the required (and optional) new employee paperwork for your review. To complete the forms, please click on the form name below. Once you've completed the forms, please print, sign and bring the forms with you on your first day of employment to the Human Resources Personnel Office.

NOTE: For security reasons, please do not email completed new employee forms to the City.


Required Forms

A helpful tool is the Paperwork Checklist linked here to recap all the documents you will need to print/fill out as part of the new hire process.

On-Line Enrollment Information - As a condition of your employment, you are required to participate in the Arizona State Retirement System. The ASRS provides for a lifelong retirement income and is a valuable benefit that is part of your overall benefit package as an employee with the City. As the Online Enrollment document stated it is vital that you enroll prior to your first day of employment so that contributions deducted from your paycheck are properly applied to your retirement account.  You will complete enrollment on your first day when you meet with Human Resources.

Arizona Minimum Wage Law

Arizona State Tax

At-Will Acknowledgement Form

Computer Use Policy and Acknowledgment

Emergency Notification

Federal Tax

Loyalty Oath - Must be signed/witnessed in Human Resources on your first day

Wage Withholding Request  
Optional Form

Direct Deposit Form


Benefits Forms

You will be required to provide appropriate documentation based on your benefit elections such as marriage certificate, birth certificate(s), social security numbers, etc. A list of enrollment verification documentation and a checklist can be found in the New Hire Benefits Workbook. If electing coverage for supplemental life insurance, you will also need to designate a beneficiary. Please be prepared with the beneficiary name, address, date of birth, and social security number.
Your benefits will not be effective until all forms are received and processed. If you are electing same day benefit coverage you MUST be prepared with all required documentation and complete your elections. Otherwise your start date will be defaulted to the first of the following month.

For more information on benefit plans please visit the Employee Benefits website at or contact the office at (480) 644-2299 Option 5 or via email at

Appointment of Personal Representative  

Benefit Enrollment Form

Flexible Spending Account Plans

Out-of-State Dependent

Supplemental Life Insurance Enrollment Form


Effective Date Options Overview

  • Option One - the employee's start date. If you are electing same day benefit coverage you MUST be prepared with all required documentation and complete your elections on your first day. Otherwise your benefits coverage start date will be defaulted to option two (the first of the following month).
  • Option Two - the first of the following month.  This is the City's default option.

After completing all the required paperwork above you will have all the documents you need on your first day of employment with the City of Mesa.  In order to be completely prepared, please be sure to use the checklist referenced above in the Required Forms section. 



Human Resources Office
20 E. Main Street
Suite 130
Mesa, AZ 85201

Employment Verification
email Employment Verification
or call 480-644-5650 and leave a detailed message.
Response within 24 hours M-TH      7a.m. - 6 p.m.

New Hire Questions
Jackie Hale
e-mail Jackie

Becky Jernigan
e-mail Becky

Employee Benefits Office
20 E. Main Street
Suite 600
Mesa, AZ 85201
Fax  480-644-4548
e-mail Benefits

Location Map

Office Hours:
Monday - Thursday
7:00 a.m. - 6:00 p.m.
Closed Fridays, weekends and holidays



Arizona State Retirement System (ASRS)