Federal W-4 Form - Tax Withholding Form
The purpose of this form is so that your employer can withhold the correct federal income tax from your pay.
State Tax Form
The purpose of this form is so that your employer can withhold the correct state income tax from your pay.
I-9 Form – Employment Eligibility Verification (See page 8 for relevant form)
The I-9 Form is a required document verifying that each new employee is eligible to obtain employment in the United States. New hires are to complete the I-9 and submit it to the Human Resources office for verification of employment eligibility. You will also need to present identity documents to the Human Resources office for verification as well (i.e., driver license and social security card).
Personal Data Sheet
The Personal Data Sheet is used by the Human Resource office as a resource tool for maintaining current information on each employee such as address, telephone number, emergency contacts, etc.
Emergency Employee Status
This form is to list your telephone numbers in case Mississippi Public Broadcasting needs to contact you outside normal working hours in case of an emergency (i.e., inclement weather conditions)
* Policy will be given to you at your orientation.
Notice of Outside Employment
The Notice of Outside Employment form is required if an employee engages in outside work or has another job. While the agency allows employees to engage in outside work or hold other jobs, it is subject to certain restrictions. The restrictions are listed in detail on the back of the Notice of Outside Employment form.
Overtime Pay Agreement
This form explains the Fair Labor Standards Act (FLSA) with regard to Non-Exempt and Exempt Status and overtime.
PERS Form 1 (Enrollment Form) and PERS Form 1B (Beneficiary Nomination Form)
These forms are needed to provide PERS with the necessary information to establish your
membership into the retirement system. For additional information on retirement visit www.pers.ms.gov
Cafeteria Plan (Enrollment Form)
This form is needed to allow participating employees the benefit of pre-taxed payments (via payroll deduction) to pay for Insurance Premiums (health, dental, vision, cancer, disability, etc.) and contribute to Flexible Spending Accounts – (Mediflex & Careflex).
Health Insurance
The Health Insurance form is needed to provide our third party administrator – Blue Cross Blue Shield with the necessary information to establish your health insurance. For additional information on Health Insurance visit http://knowyourbenefits.dfa.state.ms.us/
Life Insurance
State Term Life insurance is provided to you as an employee of the State of Mississippi. The coverage is provided through Minnesota Life Insurance Company. For additional information on Life Insurance visit http://knowyourbenefits.dfa.state.ms.us/
Direct Deposit
This form authorizes direct deposit of your MPB paycheck to your selected financial institution.
Dental Insurance (Enrollment Form)
Learn more about optional dental insurance through Delta Dental with this information sheet.
Vision Insurance (Enrollment Form)
More information on Superior Vision insurance available on this highlight sheet. See a full list of providers who accept Superior Vision with this provider directory.
