Employer information (to be completed by the employer) employer name: Section 1 should never be completed before you have accepted a job offer. The employer must maintain contemporaneous records for all claims related information and any other data or documents used to demonstrate that an employee was eligible to receive such bonus, including but not limited to employee attestations. Instead, employees are typically asked to complete and sign a form confirming their status. Have the employee complete section 1 at the time of hire (by the first day the employee starts work for pay or other remuneration) by entering the correct information and signing and dating the form. Employer attestation form (pdf) employee attestation form (pdf) ________________________ this attestation applies to the following vesting period: An employee is not able to claim bonuses independently. Web worker bonus (“hwb”) for the employer. Employer or authorized representative review and verification.
________________________ employer mmis (or sfs) number: An employee is not able to claim bonuses independently. See specific eligibility requirements and claiming guidance available through the hwb webpage: ________________________ this attestation applies to the following vesting period: Instead, employees are typically asked to complete and sign a form confirming their status. Web you, the employee, must complete each field in section 1 as described below. Web qualified employers are required to claim the bonus on behalf of their employees. The following attestations will be required for a complete claim submission: Section 1 should never be completed before you have accepted a job offer. If the employee enters the information by hand, ensure the employee prints. Employer attestation form (pdf) employee attestation form (pdf)
