View the Staff Policy Manual below. This is in PDF so you can save it to your computer and view at any time.
I have been given a copy of the Substance Abuse policy (STAFF POLICY MANUAL, SECTION S) of MFP and have had the opportunity to read the policy and ask questions. I understand the policy applies to me and my compliance with it is a condition of employment. This policy includes reasonable suspicion, pre-employment and random drug testing. I may refuse such tests but refusal to take the tests will be treated the same as a drug test with positive results and will subject me to disiplinary action up to and including termination of employment.
I understand thagt if I am suject to drug testing and choose to be tested, a sample of my urine will be collected by a trained collector at MFP. My speciment will be identified and sealed in my presence and sent to a company selected certified laboratory to be analyzed for the presence of drugs in the specified concentrations. If the evidence of drugs is detected in my specimen, a manager at MFP will make reasonable attemps to contact me and MFP will give me a copy of my test results if requested. If I am physically unable to authoritze the drug testing, MFP may authorize the testing.
I hereby acknowledge receipt of and consent to abide by the Substance Abuse Policy of MFP as outlined in the Staff Manual and understand this includes testing for drugs and alcohol in the circumstances described in the policy.
You have the capability to directly deposit your pay at any ACH accredited financial institution in the United States. Participation is required at Mattox Family Physicians.
You will need to read and sign the authorization statement and provide all the necessary information. For a checking account, you will need to bring in a void check or a copy of your check. For a savings account, please bring in evidence of your account number and routing number for that financial institution (such as a pre-printed deposit slip).
I hereby authorize Mattox Family Physicians to deposit my payroll earnings directly into the account(s) specified below. In the event of an overpayment to my account, I authorize Mattox Family Physicians to initiate an adjusting debit entry to my account up to the amount of the overpayment.
I understand the following:
Please review the HIPAA form below. The form is in PDF so you can save it to your computer and view at any time.
Please review the OSHA Training for New Employee's. This PDF is downloadable so you can save it on your computer.
The undersigned hereby acknowledges and certifies that:
In addition, the undersigned hereby agrees that:
Whether you're entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
State of Indiana
Employee's Withholding Exemption and County Status Certificate
This form is for the employer's records. Do not send this form to the Department of Revenue.
The completed form should be returned to your employer.
How to Claim Your Withholding Exemptions
Check box(es) for additional exemptions:
Before submitting, Please make sure all information is correct.