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 on our Forms page, but please contact Treasury at 515.223.1197 x2123 for assistance before mailing them to ensure everything is filled out correctly.

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Treasurer - Locally Funded Employment Form

New Hire or Termination? *

Employee Name *

First

Employee Last Name *

Last

Position/Title *

Church/School/Facility *

Board Approved Date *

Hourly Wage *

Average Number of Hours Per Week *

Termination Date *

Reason for Termination *

Date of Board Approval (if applicable)

Form Submitted by *

Your First and Last Name

Your Email Address *

Your Phone Number *

xxx-xxx-xxxx

Signature *

Clear

Provide your signature using a finger, stylus pen or mouse.

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