New Hire Forms
New hires are asked to complete necessary paperwork prior to their scheduled processing appointment with Human Resources. Please print the forms and complete the necessary information. Bring the completed forms to your appointment with Human Resources for processing and pre-placement screening. Forms include:
  1. Employment Eligibility Verification Form (I-9)
    (Please bring the following to your processing appointment: Ohio Driver's License and either a Social Security Card or Birth Certificate or U.S. Passport)
  2. Form W-4
  3. Enrollment/Change Form (Application for Health Insurance)
    (Please bring the following to your processing appointment: Proof of Spouse - Marriage Certificate or Tax Documentation; Natural Born Children and Step-Children - Birth Certificate, Hospital Certificate or Tax Documentation; Adopted Child - Final Adoption Papers or Tax Documentation)
  4. Pre-Tax Health Insurance Premium Plan Enrollment Form and Authorization for Payroll Deduction
  5. AIG Group Employee Enrollment Form (Life Insurance)
  6. Parking Registration Form
  7. Direct Deposit Enrollment Form
  8. Request to Access Firelands Computer Resources
  9. Ohio Taxation Form
  10. Employee Safe Driving Guidelines
  11. Pyxis Medstation 2000/3500 Identification/Password/Bio-ID Assignment
  12. 10-Hour Shift Policy Review, Understanding & Selection
  13. 12-Hour Shift Policy Review, Understanding & Selection
  14. Employee Emergency Information Form

  15. NCPC W-4 Form - NCPC EMPLOYEES ONLY
  16. NCPC Health Insurance Enrollment Form - NCPC EMPLOYEES ONLY
  17. NCPC Employment Eligibility Verification From (I-9) – NCPC EMPLOYEES ONLY
  18. Pre-Tax Health Insurance Premium Plan Enrollment Form and Authorization for Payroll Deduction – NCPC EMPLOYEES ONLY
  19. NCPC Life and AD & D Insurance Enrollment Form – NCPC Employees
About Us
Firelands Regional Medical Center is committed to being big enough to care FOR you, and small enough to care ABOUT you.  With our advanced regional care, Firelands Regional Medical Center offers the following core services to you and your family:
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What We Do
Firelands Regional Medical Center offers the latest healthcare technologies and treatments to the community. Patient centered service, leading edge technology - all available close to home.
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