Employee Roster Information

Information Collection Sheet

IMPORTANT: Be sure to include ALL employees of your church, including those who are full-time, part-time, eligible for benefits, ineligible for benefits, etc.
Employee Name(Required)
Home Address(Required)
Mailing Address(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Type of Position:(Required)
Marital Status:(Required)
If married, the below spouse information is required to process your information.
MM slash DD slash YYYY
MM slash DD slash YYYY
Source of Medical Coverage:(Required)
Level of Medical Coverage:(Required)
Currently Enrolled in which pension program?(Required)
Employer contributes to pension?(Required)