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.
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.
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. Please click on
the Online Enrollment document for important information on the
ASRS online enrollment process.
State Retirement System Enrollment Form - please click the
link to access the ASRS enrollment site.
You will need the following codes for the on-line system:
1st Panel enter 58200055 and click the Enter button
2nd Panel choose from the drop down "City of Mesa" and click the
Arizona State Retirement System Beneficiary - Online
After entering your demographic data you will be directed to
create a login ID and password for your personal ASRS online
account. Once your account is created you will have access to a
limited online account where you can name a primary beneficiary.
Arizona Minimum Wage Law
Arizona State Tax
At-Will Acknowledgement Form
Computer Use Policy and Acknowledgment
Loyalty Oath - Must be signed/witnessed in Human Resources on your first day
Wage Withholding Request
Direct Deposit Form
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
http://www.mesaaz.gov/benefits or contact the office at
(480) 644-2299 Option 5 or via email at
Appointment of Personal Representative
Benefit Enrollment Form
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
Mesa, AZ 85201
email Employment Verification
or call 480-644-5650 and leave a detailed
Response within 24 hours M-TH 7a.m. -
New Hire Questions
Employee Benefits Office
20 E. Main Street
Mesa, AZ 85201
Monday - Thursday
7:00 a.m. - 6:00 p.m.
Closed Fridays, weekends and holidays
Arizona State Retirement System (ASRS)