Human Resources Management
Harborview Office Tower
19 Hagood Avenue-Suite 102
PO Box 250800
Charleston, SC 29425
Welcome to MUSC! It is our pleasure to have you as part of our team. We know how
busy you are and the amount of written communication you will receive regarding your
employment with MUSC. Please take a few minutes to review and complete the
enclosed information. This packet contains mandatory documents to establish
employment and enroll in benefits. Carefully follow the instructions for
“Completing New Hire Paperwork” on the next page. Information and mistakes
that are omitted may affect your payroll status. We want to ensure that your transition
to MUSC is seamless.
We ask that you complete the paperwork, print and sign the forms in ink and mail back to
us prior to Orientation. Please note that you have 31 days from your hire date to make
a change to any of the benefits that you select. We have created a “MUSC Resident”
website that contains all of the resources you will need to select your benefits. If you
have questions while completing these forms, please contact the Benefits Office at (843)
We will review your paperwork once received, to ensure that all forms are completed
accurately and completely. We may contact you prior to Orientation to obtain
information and will also be available at Orientation to assist you with any questions you
Do not complete the paperwork and return the packet via email. We require the forms
with original signatures. Complete the New Hire Paperwork and mail all documentation
and forms by June 1, 2009 to:
MUSC Human Resources
19 Hagood Avenue-Suite 102
Charleston, SC 29425
Please feel free to contact us if you have any questions!
Dee Crawford, Lisa Beattie, LaDeidra Berry, and Patrice Gordon
Completing New Hire Paperwork
Please use a ballpoint pen when completing these forms!
We recommend you review the following resources prior to completing your
paperwork: the Benefits Presentation, “Insurance Orientation Handbook”,
“Comparison of Health Plans”, and “Select Your Retirement” brochures.
Page 1: Pre-Employment Packet
Complete all of your personal information in the fields highlighted yellow. This
information will populate throughout the packet.
Page 2: Assignment Information Sheet
Verify your name, ss number and employment information. Sign and date the form.
Page 3: Code of Conduct
Read the MUSC Code of Conduct. Sign and date the form.
Page 4: The Drug-Free Workplace Act of 1988
Read the Act. Sign and date the form.
Page 5: Employee Citizenship Identification
Complete all fields including signature and date at the bottom of the form.
-If you are a Green Card Holder, please attach a copy of your Permanent
-If you are on a Visa, please attach a copy of your visa, I-94 and I-797 forms.
Please read the I-9 Instructions
Page 9: Form I-9, Employment Eligibility Verification
Complete Section 1 including employee signature and date. Attach a photocopy of the
documents listed in the “List of Acceptable Documents” on Page 10. You may provide a
copy of one document in List A or a copy of two documents from List B AND List C.
We would prefer a copy of your driver’s license and social security card because the
social security card is a document required to be kept in your file by the Social Security
Administration. If you do not have a copy of your social security card, please contact
your local Social Security Office now to obtain a copy- this is mandatory for your
employment! Your MUSC records will be based on the name shown on your social
security card per IRS regulations.
Page 10: List of Acceptable Documents
Page 11: Form W-4
Complete the bottom half of the form. Select the appropriate taxes. Numbers 1 through
5 are mandatory. Sign and date at the bottom. Please note that the “Personal
Allowances Worksheet” and the “Deductions and Adjustments Worksheet” is used
for your personal calculations. It is not mandatory that this section be completed.
Page 12: Deductions and Adjustments Worksheet
To be used to calculate your taxes. It is not mandatory that you complete this form.
Page 13: Direct Deposit Authorization
Direct deposit is mandatory. Complete all information and attach a voided check or a
direct deposit form completed by your bank. For “Amount of Deposit”, “Total”
means your entire check will be deposited. The account number and routing
number must be displayed. DEPOSIT SLIPS AND DEBIT CARD NUMBERS
ARE NOT ACCEPTABLE!
Page 14: Invitation to Self-Identification
Please read this form.
Page 15: Personal Self Identification Form
Complete all information, sign and date.
Page 16: Veterans Self-Identification Form
Complete any applicable information
Page 17:Active Notice of Election: PLEASE FOLLOW DIRECTIONS
CAREFULLY-FORMS CANNOT HAVE ERRORS!
-In the top right corner:
-MoneyPlu$: mark “Yes” or “No” to have your health, dental and up to $50,000
of optional life insurance premiums deducted from your paycheck before taxes.
-Health Savings Account: you may only elect this if you have enrolled in the SHP
-Complete # 1-16.
-Only complete #20 if you or any other persons covered on your insurance are eligible for
YOU MAY NOT CARRY YOUR SPOUSE AND/OR CHILDREN ON YOUR
INSURANCE IF THEY ARE A STATE EMPLOYEE OR COVERED BY STATE
INSURANCE. REMEMBER: NO ERRORS ON THIS FORM!
-#21: Select a health plan. Mark off the box for Standard or Savings. If you are choosing
CIGNA or BlueChoice check off HMO and type in the appropriate plan name. Mark off
the category of coverage you are selecting.
**If you have enrolled in a health plan, you automatically receive $3,000 Basic Life
coverage and Basic Long Term Disability.
-#22: Select a dental coverage level.
-#23: Refuse or select Dental Plus. You must carry the same category of coverage and
pay the premium for the basic AND plus plans.
-#24: Refuse or select Dependent Life-Children. You are the beneficiary.
-#25: Refuse or select coverage for Dependent Life-Spouse. This is insurance on your
spouse and you are the beneficiary. If your spouse will be an MUSC employee or is
currently a SC State employee, you may not select this option. You can only select a
guaranteed issue of $10,000 or $20,000 at this time. Additional coverage can be
approved by completing a Medical Questionnaire. Please request this form at
-#26: Refuse or select coverage amount. The maximum guaranteed amount is three times
your base salary, rounded down to the next ten thousand or any amount less than the max
in increments of $10,000. You may not select more at this time. Additional coverage can
be approved by completing a Medical Questionnaire. Please request this form at
-#27: Refuse or select either of the Supplemental Long Term Disability Plans. If you
refuse, you will still be covered by the Basic Long Term Disability Plan, after one year of
REMEMBER: NO ERRORS ON THIS FORM!
-In the “Beneficiaries Info” section, it is mandatory that you list a Basic Life Beneficiary
if you have enrolled in health insurance and an Optional Life beneficiary if you have
enrolled yourself in Optional Life(#26). If you would like to list the same person, check
off both boxes. Please mark if the beneficiary is Primary or Contingent. DO NOT
MAKE ANY ERRORS IN THIS SECTION!
-In the “Dependent Information” section, list any family member that you will be
covering under your health, dental or life insurances. YOU MUST PROVIDE SS# AND
DATE OF BIRTH FOR EACH PERSON LISTED. IF THIS INFORMATION IS
NOT LISTED THEY WILL NOT BE COVERED!
-#31: Only complete this section if your dependents will continue coverage with another
plan while currently covered under this insurance.
-SIGN AND DATE AT THE BOTTOM.
-If a dependent is over the age of 19 and is a full-time student in college, please
provide a letter from the registrar’s office stating that they are a FT student.
Page 19: MoneyPlu$ Enrollment: Complete section A and/or B only if you have
enrolled in the State Savings Plan. To enroll in a Health Savings Account you must also
go online to apply for the account. The website is Complete section D to enroll in a
Dependent Care Account. Sign and date.
Page 20: RETIREMENT INFORMATION SHEET: Read this form to understand the
eligibility for retirement. Sign and date at the bottom.
Page 21: Election of Non-Membership
Complete this form to waive your participation in both of the SC State Retirement plans.
Sign and date in the middle of the page. If you select Non-Membership, you may not
enroll at a later time unless your position requires participation. You do not need to
complete the enrollment and beneficiary forms if you select Non-Membership.
Page 22: Retirement Plan Enrollment: Complete this form if you want to participate in
the SC Retirement System or the State Optional Retirement Plan. You have 30 days from
your hire date to make a selection. If you do not make a decision within the allotted time
period, you will automatically default to Non-Membership and you may not enroll at a
later time unless your position requires participation. Please refer to the “Select Your
Retirement” brochure for more information. Remember “election of membership is
permanent” so once you elect to participate you cannot cancel.
-Complete sections #1-#14.
-#15: Select either SCRS or State ORP.
-#16: If you select the State ORP, please select a vendor.
-Please complete the appropriate enrollment form for the vendor you have
selected. These forms can be found on the “MUSC Residents” website. If you do
not complete the enrollment form your money will be held in a suspense
account and will not accrue any interest.
-Read the certification in #17, sign and date.
Page 23: SCRS Active Member Beneficiary Form: Complete this form if you have
selected the SCRS plan or if you are undecided at this point. No errors are permitted in
Section II-A, II-B, or III. List a beneficiary to receive a refund of your retirement
contributions and the Group Life Benefit. Sign at the bottom of the page under
Page 24: State ORP Beneficiary Form: Complete this form if you have selected the
State Optional Retirement or if you are undecided at this point. List a beneficiary to
receive the Group Life Benefit. No errors are permitted in Section II. Sign at the
bottom of the page under “Member’s Signature”.
PLEASE NOTE THE SECTIONS WHERE ERRORS ARE NOT PERMITTED.
NO CROSS-OUTS, WHITE-OUT OR WRITE-OVERS ARE ALLOWED.
RETURN THE COMPLETED PACKET NO LATER THAN JUNE 1, 2009
ALONG WITH ALL REQUESTED PHOTOCOPIES IN THE ENCLOSED