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Form Hr 101 V4 PDF Details

If you have a business, then you have employees. And if you have employees, then you need to know about Form HR 101 V4. This is the form that all employers in California must use to report employee wages and hours to the state government. Don't let your business fall behind - make sure you're up-to-date on the latest Form HR 101 V4 requirements! (And if you're not sure how to complete the form, we've got you covered there too.

Here is the information in regards to the file you were seeking to fill in. It can show you how much time it will need to finish form hr 101 v4, exactly what parts you will have to fill in and a few additional specific details.

Question	Answer
Form Name	Form Hr 101 V4
Form Length	6 pages
Fillable?	Yes
Fillable fields	352
Avg. time to fill out	35 min 59 sec
Other names	TCs, PRSI, hr 101 form, hr101

12

Form Preview Example

if you have had multiple assignments with these employers please provide details of your latest employment)

Employee Set up form HR 101

This form is to be completed for all new entrants and forwarded to Personnel Administration.

Please complete in block capitals & place a tick  in the appropriate boxes

Hire

Re-hire

Internal HSE Payroll Transfer

Permanent

Temporary

Personnel Number

Start Date

D

D

M

M

Y

Y

Y

Y

Sections 1-9 should be completed by Employee.

1. Personal Information

Title

Mr

Mrs

Ms

Miss

Dr

Sr.

Rev.

Fr.

Prof.

Surname

First Name

Known as

Initials

Street Address

Town/City

County

Post Code

Country

Phone No

Mobile Phone No

Email address

Maiden Name

Nationality

Gender

Male

Female

Date of

D

D

M

M

Y

Y

Y

Y

Birth

Marital Status

Single 

Married  Civil Partnership 

Widowed  Divorced 

Separated  Co-Habiting 

Relevant certificate/s attached

Yes

No

PPS

Number

2. Next of Kin (Emergency Contact Details)

Surname

First Name

Relationship to you

Street

Address

Town/City

County

Post code

Country

Contact Phone No

Mobile Phone No

3. Employment History

Are you Currently employed by HSE / Public Service

Yes

No

If currently employed by HSE please provide details of your personnel

Personnel Number

Pay group / payroll

area

number and pay group/payroll area.

Were you previously employed by HSE / Health Board / Voluntary Hospital / National Hospital/ Public Service

Employer?

Yes

No

If No please go to section 4

If previously employed by HSE / Health Board / Voluntary Hospital / National Hospital please provide the following details. (Note:

Name of employer		Last Day of
Name of employer		service
		service
Grade		Personnel
Grade		Number
		Number

D D

M M

Y

Y Y

Y

HR 101_V4 Sep 2012

Page 1 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

Are you in receipt of a pension under the Local Government Superannuation Scheme or HSE Superannuation

Scheme? Yes No

If Yes please provide information requested below

Name of Authority/		Start Date of
Employer		Payment

D

D

M M

Y Y

Y Y

4. Bank Details

Bank Name

Bank Address

Bank Sort Code

Account No

Payee Name

5 Professional Registration

Note: only applies to Medical & Dental, Health & Social Care Professionals & Nursing. If this section does not apply to you go to section 6. If you have multiple registrations please complete Appendix 1.

Name on

Issued

Registration

By

Date of issue

D

D

M

M

Y

Y

Y

Y

Expiry

D

D

M

M

Y

Y

Y

Y

Date

Professional Registration / Membership Number

6. PRSI Details

PRSI Class:

	Are you a Full Medical Card Holder?	Yes	No
	Are you a GP Visit Card Holder?	Yes	No	Note: if you have answered yes to any of these questions
	Are you a GP Visit Card Holder?	Yes	No	please attach supporting documentation from Dept of Social
	Are you a widow / widower?	Yes	No	please attach supporting documentation from Dept of Social
	Are you a widow / widower?	Yes	No	Protection (Social Welfare) or HSE
	Are you a lone Parent?	Yes	No

7. Qualification Details

Note: Copy of Certificates to be attached

Official use only

Name of Qualification

Date from

Proficiency/

Qualification Code

Validated

Grade awarded

(if applicable)

Please () tick one

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

D

D

M

M

Y

Y

Y

Y

Yes

No

HR 101_V4 Sep 2012

Page 2 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

8. Irish Language Proficiency

Oral Irish

Validated

Native

Intermediate

Fluent

Beginner/ Novice

None

Unknown / Untested

Yes

No

Written Irish

Advanced

Intermediate

Basic

None

Unknown / Untested

Yes

No

9. Employee Declaration

I declare that the above information is accurate and correct on the date below. I undertake to notify my employer of any

changes to this information by completing and submitting the appropriate form.

Signature

Date

D

D

M

M

Y

Y

Y

Y

Sections 10 - 18 should be completed by Line Manager/ Human Resources

10. Appointment Details

Employed as (Grade)

Position Name

Position

Number

Cost Centre

Care Group

Personnel Area

Work Address

Employee Group

Permanent

Temporary

Officer

Non Officer

Employee Sub Group

Wholetime

Part-time

Casual

Fees/ Sessions

Job share

Flexible

Working

Fill Existing Vacancy



Maternity Leave Relief 

Locum Relief 

Fill New Vacancy 

Sick Leave Relief 

National Transfer



Reason for Appointment

Special Project 

Annual Leave Relief 

Local Transfer



or Action

Student Training Post 

Career Break Cover 

Redeployment 

Community Employment Scheme 

Urgent Service Needs

SJH Hire Pension Purposes Only 

(Special)

Student Summer Scheme 

Locum On-Call Relief 

Agency Subsumed into HSE 

Name of Replaced Employee:

Replaced Employee

Personnel No.

11. Contract – (please attach signed contract)

Contract Type

Indefinite

Indefinite Duration

Fixed Term

Fixed Term

Specified

Specified Purpose

Duration

Std T&C’s

Std T&C’s

Purpose

Std T&C’s

Consultant Contract type

A

B

B*

C

Expiry Date of

Temporary Contract

D

D

M

M

Y

Y

Y

Y

Probation period to be served

Yes

No

(if applicable)

1st probationary

D

D

M

M

Y

Y

Y

Y

2nd

probationary

D

D

M

M

Y

Y

Y

Y

Review date

Review date

12. Allowances - Please ensure that supporting documentation is attached

Allowance

Amount / Unit

Wage Type / Pay code

Official use only

1

2

HR 101_V4 Sep 2012

Page 3 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

13. Work Pattern

Standard Full Time hours for this grade			Contract Hours (use decimals)

Work Schedule rule details (SAP Phase II Sites Only)

Working Week	Mon – Fri 5/5	Mon – Sun 5 / 7

Note: If an employee works a Monday to Friday roster they are classed as 5/5. These employees will never be paid Saturday allowance, Sunday premiums or Public Holiday premiums. Alternatively if an employee may work on a Saturday or Sunday they are classed as 5/7, this will allow them to be paid the relevant allowances and premiums

Work Schedule Rule*

Start week of Rotational Roster

* (If employee is casual, enter HRPD)

14. Pay Details

Work Location

Annual Salary

Level (Point of Scale)

Grade Code

Next Increment due

D

D

M

M

Y

Y

Y

Y

Payroll Area/Group No

Pay slip distribution

Internal

External

Email

Payroll Frequency

Weekly

Fortnightly

4 weekly

Monthly

16 Pension Details

Is this employee eligible for membership of a superannuation scheme

Yes

No

Please indicate the relevant main superannuation scheme and either the Spouses’ & Children’s or Widows’ & Orphans’ Scheme

	Scheme (employees appointed			Officers						Non-Officer
	before 1/1/2005 with no break in
	before 1/1/2005 with no break in		PRSI Class A			PRSI Class D
	service)		PRSI Class A			PRSI Class D
	1956 Scheme			120				120			200
	Main Scheme (1977)			160				140			220
	Spouses’ & Children’s			320				320			420
	Widows’ & Orphans’		N/A					300			400
	Scheme (All New HSE employees appointed from 1 January 2005)								All Staff
	Main Scheme									165
	Spouses’ & Children’s									325
	Superannuation Classification (to be completed in all cases)
	New Entrant
	Non New Entrant
	Non New Entrant

HR 101_V4 Sep 2012

Page 4 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

17. Service year date (for annual leave purposes)

Note: Certain grades are entitled to incremental increases to the annual leave entitlement based on length of service in the grade. Please complete the following section so that the correct entitlement may be established.

Is the employee entitled to incremental increases to annual leave, based on length of service?

Yes

No

If No Go To Section 18

Nursing Grades only

If yes please enter the number of years, months and days of previous service.

Note: Please include all previous service in publicly funded health services in Ireland and relevant nursing experience abroad

Years

Months

Days

Other Grades

If yes please enter the number of years, months and days of relevant service at

this grade Note: Please include service if the employee was acting up continuously in the same grade immediately prior to start date

Years

Months

Days

18. Line Manager Declaration

Note: Please ensure P45 / Certificate of Tax Cut Off / PRD45 are forwarded to the appropriate payroll department

Fit Slip Attached

Yes

No

I declare that the above information is accurate and correct. I confirm that the above employee commenced employment on the date stated above and approve set up on the appropriate payroll system.

Signature

Name (Print)

Contact Tel No

E-Mail Address

Date	D	D	M	M	Y	Y	Y	Y

Grade

Decision Number (if applicable)

19. Delegated Officer approval

Name (Print)

Tel No

Decision No

Signature

Date	D	D	M	M	Y	Y	Y	Y

20. Area Employment Monitoring Group

Approval Number

Date

D D M M

Y

Y Y Y

21. To be completed by Human Resources Personnel Administration

System Updated by	Date	D	D	M	M	Y	Y	Y	Y

Comments

HR 101_V4 Sep 2012

Page 5 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

22. Payroll Section

Location Code

Name (Print)

Signature

Tel No

Date

D

D

M

M

Y

Y

Y

Y

23. Payroll Interface (phase 1 Only)

Wage Type Entered

Employment Signal

Payroll Area Change Details

Date

D

D

M

M

Y

Y

Y

Y

Main Pension Scheme

W&O/Spouses Scheme

PAC Completed

Date

D

D

M

M

Y

Y

Y

Y

Signed

24. Circulation List

1

5

2

6

3

7

4

8

Appendix 1 Professional Registration additional information for multiple registrations

Note only applies to Dentists, Doctors, Nurses, Ophthalmologists, or Pharmacists

Name on

Issued

Registration

By

Date of issue

D

D

M

M

Y

Y

Y

Y

Expiry

D

D

M

M

Y

Y

Y

Y

Date

Professional Registration / Membership Number

Name on

Issued

Registration

By

Date of issue

D

D

M

M

Y

Y

Y

Y

Expiry

D

D

M

M

Y

Y

Y

Y

Date

Professional Registration / Membership Number

Name on

Issued

Registration

By

Date of issue

D

D

M

M

Y

Y

Y

Y

Expiry

D

D

M

M

Y

Y

Y

Y

Date

Professional Registration / Membership Number

HR 101_V4 Sep 2012

Page 6 of 6

Revised 25/09/2012

How to Edit Form Hr 101 V4 Online for Free

It's straightforward to fill out the PRSI. Our PDF editor was intended to be help you complete any PDF easily. These are the steps to follow:

Step 1: The initial step will be to click the orange "Get Form Now" button.

Step 2: After you have accessed the editing page PRSI, you will be able to find each of the actions available for the document within the upper menu.

These areas are contained in the PDF document you'll be completing.

stage 1 to writing V4

Fill in the Maiden, Name Gender, Male Female, Nationality, DateofBirth, DD, MM Relevant, certificates, attached, Yes PP, S, Number First, Name Relationship, to, you Street, Address Town, City County, Postcode, and Country field with all the data requested by the platform.

Completing V4 stage 2

You should be demanded some essential information so you can complete the Name, of, employer Grade, Last, Day, of, service, Personnel, Number DD, MM HR, V, Sep Page, of and Revised section.

V4 Nameofemployer, Grade, LastDayofservicePersonnelNumber, DDMM, HRVSep, Pageof, and Revised blanks to fill out

Please be sure to identify the rights and obligations of the parties inside the Name, of, Authority, Employer, Bank, Details Start, Date, of, Payment D, MM Bank, Name Bank, Sort, Code Payee, Name Account, No Bank, Address and Professional, Registration space.

stage 4 to filling out V4

End by reviewing these sections and writing the relevant data: Name, on, Registration Date, of, issue DD, MM Issued, By Expiry, Date PRS, I, Details PRS, I, Class Are, you, a, Full, Medical, Card, Holder Yes, Are, you, aGP, Visit, Card, Holder Are, you, a, widow, widower Are, you, alone, Parent Yes, Yes, and Yes.

Finishing V4 step 5

Step 3: When you have selected the Done button, your document will be accessible for upload to any electronic device or email address you identify.

Step 4: Be sure to make as many duplicates of your document as you can to keep away from potential problems.

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