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Fill Out Your Hr 101 V4 Form

The HR 101 V4 form is an essential document required for setting up new employees within the organization. It gathers important personal information, employment history, and other details necessary for payroll and human resources processes. Completing and submitting this form accurately ensures a smooth onboarding experience.

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The HR 101 V4 form is a crucial document used in the employee onboarding process, ensuring that all relevant personal and employment information is collected for new hires. This form is designed to capture a wide range of details, including personal information, emergency contacts, employment history, and bank details. Employees are required to fill out sections that pertain to their qualifications and professional registrations if applicable. Importantly, the form also includes spaces for the employee's declaration, confirming the accuracy of the information provided. For employers, sections to be completed by the line manager or human resources detail appointment information, contract specifics, work patterns, and payroll options. It’s essential that all parts of the HR 101 V4 form are completed accurately and submitted promptly to avoid any delays in payroll setup and other essential administrative processes. The thoroughness of this form not only supports organizational compliance but also facilitates a smooth transition for new employees into their roles.

Hr 101 V4 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

Sections 1-9 should be completed by Employee.

1. Personal Information

Title

Mrs

Miss

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

Birth

Marital Status

Single 

Married  Civil Partnership 

Widowed  Divorced 

Separated  Co-Habiting 

Relevant certificate/s attached

Yes

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

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

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

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

M M

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

Date of issue

Expiry

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

Yes

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

Written Irish

Advanced

Intermediate

Basic

None

Unknown / Untested

Yes

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

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

Specified

Specified Purpose

Duration

Std T&C’s

Purpose

Std T&C’s

Consultant Contract type

Expiry Date of

Temporary Contract

Probation period to be served

Yes

(if applicable)

1st probationary

2nd

probationary

Review date

12. Allowances - Please ensure that supporting documentation is attached

Allowance

Amount / Unit

Wage Type / Pay code

Official use only

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

Payroll Area/Group No

Pay slip distribution

Internal

External

Payroll Frequency

Weekly

Fortnightly

4 weekly

Monthly

16 Pension Details

Is this employee eligible for membership of a superannuation scheme

Yes

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

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

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

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

23. Payroll Interface (phase 1 Only)

Wage Type Entered

Employment Signal

Payroll Area Change Details

Date

Main Pension Scheme

W&O/Spouses Scheme

PAC Completed

Date

Signed

24. Circulation List

Appendix 1 Professional Registration additional information for multiple registrations

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

Name on

Issued

Registration

Date of issue

Expiry

Date

Professional Registration / Membership Number

Name on

Issued

Registration

Date of issue

Expiry

Date

Professional Registration / Membership Number

Name on

Issued

Registration

Date of issue

Expiry

Date

Professional Registration / Membership Number

HR 101_V4 Sep 2012

Page 6 of 6

Revised 25/09/2012

Get Hr 101 V4 PDF Form

Form Characteristics

Fact Name	Description
Purpose of Form	The HR 101 V4 form is used for the setup of new employees and must be submitted to Personnel Administration.
Personal Information Required	Sections 1-9 require the employee to provide personal details like name, address, contact numbers, and marital status.
Emergency Contact	Section 2 asks for next of kin details, ensuring there is an emergency contact available at all times.
Employment History	Section 3 inquires about current and past employment, particularly with health services to establish eligibility for benefits.
Bank Details	Section 4 requires employees to provide bank information for payroll processing, including account number and bank sort code.
Governing Law	This form is governed by employment and labor laws in the United States, specifically for healthcare and public services.

Guidelines on Utilizing Hr 101 V4

Completing the HR 101 V4 form is an important step for new employees in the hiring process. The information collected will be used to establish your employment record with the organization. Below are detailed steps to assist in filling out the form accurately.

Personal Information: Begin with your title, surname, first name, and initials. Provide your street address, town or city, county, post code, and country. Include phone numbers, email address, and maiden name. State your nationality and gender, then enter your date of birth and marital status. Attach relevant certificates and input your PPS Number.
Next of Kin: Fill in the name, relationship, address, and contact details of your emergency contact.
Employment History: Indicate whether you are currently employed by HSE or any public service. If yes, provide your personnel number and pay group details. If previously employed, detail the employer’s name, last day of service, grade, and personnel number. Check if you receive a pension and provide the necessary date of employer payment.
Bank Details: Enter the bank name, bank address, sort code, account number, and payee name for payroll purposes.
Professional Registration: If applicable, provide details regarding your professional registration including the name, date of issue, and any relevant expiry dates and registration numbers.
PRSI Details: State your PRSI class and indicate if you hold a full medical card or GP visit card. Attach supporting documentation if applicable.
Qualification Details: List your qualifications, along with the date of receipt and validation details. Attach copies of certificates.
Irish Language Proficiency: Indicate your proficiency in oral and written Irish, selecting the appropriate levels.
Employee Declaration: Read the declaration, sign, and date the form to confirm the accuracy of the information provided.
Line Manager / Human Resources Section: The line manager or HR will complete the appointment details, including job position, contract type, allowances, work pattern, pay details, superannuation eligibility, and service year date.

Carefully review your form before submission to ensure all required sections are filled out completely. Providing accurate information will help facilitate a smooth employment setup process.

What You Should Know About This Form

What is the purpose of the HR 101 V4 form?

The HR 101 V4 form is intended for capturing essential information for all new employees entering the organization. It needs to be filled out completely and sent to Personnel Administration for processing. This information includes personal details, employment history, bank details, and qualifications that are important for employee records and payroll processing.

Who is required to fill out the HR 101 V4 form?

All new entrants to the organization must complete the HR 101 V4 form. This includes individuals being hired for the first time, those being rehired, or employees transferring from other positions within the organization. The form helps ensure the organization has accurate and up-to-date information on each employee.

What kind of personal information is requested on the form?

Personal information requested includes the employee's title, name, contact details, nationality, gender, date of birth, and marital status. Additionally, details about the employee's next of kin for emergency contacts are also required. This information is crucial for ensuring proper communication and support for employees.

Are there specific sections for different types of employment history?

Yes, the form features sections dedicated to employment history. Employees are asked if they are currently employed by the Health Service Executive (HSE) or other public services. If they previously worked for HSE or related organizations, they must provide details, including their last day of service and personnel number. This helps the organization track previous experience and benefits eligibility.

What documentation is required to be attached to the HR 101 V4 form?

Employees must attach certain documentation as specified in various sections of the form. For example, copies of qualifications must be submitted along with any relevant certificates for professional registrations, if applicable. Furthermore, supporting documentation regarding PRSI details and any social welfare benefits must also be included when mentioned.

What happens if an employee has multiple positions or previous employers?

If an employee has multiple assignments with different employers, they should provide details regarding their latest employment on the form. This ensures that personnel records are comprehensive and that any previous employment history is noted for benefits and service assessments.

How does the employee declaration section function?

The employee declaration section of the form requires the individual to confirm that the information they provided is accurate. They agree to notify the employer of any changes by submitting the appropriate forms. This declaration helps maintain the integrity of the information within the human resources system.

What is the significance of the sections completed by the line manager and Human Resources?

Sections completed by the line manager and Human Resources are essential for documenting the appointment and contract details of the employee. These sections include job descriptions, contract types, allowance information, pay details, and employee classification. This process ensures that all employment-related details are thoroughly reviewed and verified by authorized personnel.

Common mistakes

When filling out the HR 101 V4 form, there are several common mistakes that can lead to delays or complications with your employment process. First, many employees forget to complete the form in block capitals. Handwriting that is difficult to read can cause confusion and lead to errors in your personal details. Ensure that all sections are filled out carefully, so your information is clear and legible.

Another frequent error is neglecting to tick the appropriate boxes in the correct sections. This includes indicating whether you are a new hire or a re-hire and providing correct employment history. Failing to do so can result in the processing team not having necessary background information to finalize your employment. Pay special attention to these details. Every box counts.

The section on next of kin often receives little attention. Some applicants leave this blank, which is a significant oversight. Emergency contacts are vital for workplace safety. Always provide a complete and accurate contact for emergency situations, including their relationship to you and an updated phone number.

In addition, many individuals forget to attach required documentation. Whether it's proof of professional registration or bank details, supporting documents must be included for verification. This documentation is essential to ensuring that your application is complete. Skipping this step can result in unnecessary processing delays.

Lastly, the employee declaration section at the end is sometimes rushed. Employees should not overlook the importance of signing and dating this section properly. An unsigned form or one without a date will likely be rejected, causing you to resubmit your application. Take the time to ensure that every part of the form is completed and verified.

Documents used along the form

The HR 101 V4 form is essential for setting up new employees within an organization. However, several other documents complement this form to ensure a smooth onboarding experience. Each document serves a specific purpose and provides necessary additional information that helps with employee processing. Below is a list of these commonly used forms.

Employee Declaration Form: This form is where new employees affirm that the information provided is accurate. It is fundamental for verifying the integrity of the onboarding process.
Tax Forms (W-4/1040): These documents are crucial for determining how much federal income tax should be withheld from an employee's pay. Correct completion affects future tax liabilities and deductions.
Direct Deposit Authorization Form: This form allows employees to authorize their employer to deposit their pay directly into their bank accounts, providing convenience and efficiency in payroll processing.
Benefits Enrollment Form: Employees use this form to select health insurance coverage, retirement plans, and other benefits offered by their employer. Making these selections typically occurs shortly after hiring.
I-9 Employment Eligibility Verification: This document is required by law to confirm that an employee is eligible to work in the United States. It includes verifying the employee's identity and employment authorization.

Collectively, these forms and documents support the HR 101 V4 form in various aspects of employment, ensuring that both the employer and employee comply with necessary regulations and policies. Proper completion of these documents streamlines the onboarding process and lays a solid foundation for the employment relationship.

Similar forms

Employee Personal Information Form: Similar to the HR 101 V4 form, this document collects essential personal details of new hires. It typically requires information such as the employee's name, address, and contact details. The goal is to ensure that the employer has well-documented records for communication and legal compliance.
Emergency Contact Form: This form is designed to gather emergency contact information, akin to the section on next of kin in the HR 101 V4. It ensures that in urgent situations, the company can quickly reach out to someone the employee trusts.
Tax Information Form (W-4): Like the HR 101 V4, this document is crucial for onboarding. It provides the employer with essential tax information from the employee. Both forms play vital roles in ensuring legal compliance and accurate financial records.
Employment History Record: This document requests past employment details, similar to the employment history section in the HR 101 V4. It helps employers verify qualifications and experiences that are crucial for the new position.
Bank Detail Form: This document is required for payroll processing and collects the employee's bank account information. It mirrors the bank details section in the HR 101 V4 form by ensuring that employees receive their pay promptly and accurately.

Dos and Don'ts

When filling out the HR 101 V4 form, there are certain practices that can help ensure the process is smooth and efficient. Below are some important do's and don'ts to consider:

Do complete all sections in block capitals to improve readability.
Do provide accurate and truthful information to avoid delays.
Do attach any required supporting documents, such as certificates or proof of identification.
Do double-check the form for any errors before submission.
Don’t leave any sections blank that are applicable to your situation.
Don’t use abbreviations or informal language when completing the form.
Don’t forget to sign and date the form at the end to validate your submission.

Following these guidelines will help expedite your application process and ensure that all necessary information is included for review. It is essential to approach this matter with care and attention to detail.

Misconceptions

Misconception 1: The HR 101 V4 form is only for new hires.

This form applies to both new hires and re-hires, as well as internal transfers. It allows the organization to consolidate employee information regardless of their employment history.

Misconception 2: Only HR departments need to fill out this form.

While HR processes the form, it must first be completed by the employee. Sections 1-9 require personal information directly from the employee, ensuring all details are accurate.

Misconception 3: The form can be filled out in any format.

The HR 101 V4 form must be completed in block capitals, as specified. This requirement enhances readability and minimizes errors during data entry.

Misconception 4: Once submitted, updates to the information are not allowed.

Employees are responsible for notifying HR of any changes to their information. Completing the appropriate form ensures that records remain current.

Misconception 5: All sections of the form must be completed by the employee.

Only sections 1-9 are to be completed by the employee. Sections 10-18 are designated for the line manager or HR personnel, indicating a collaborative process.

Misconception 6: There is no need for supporting documents with the form.

Several sections ask for supporting documents, such as proof of qualifications or professional registration. Failure to include these could lead to processing delays.

Misconception 7: Employees need to fill out the PRSI details section regardless of their status.

The PRSI details section is only necessary if applicable to the employee. If not, it can be skipped, making the form less cumbersome.

Misconception 8: Submitting the form electronically means it doesn't need to be printed.

When faxing the form, it's essential to include the employee’s name and personnel number on every page. This ensures accuracy and helps identify the submission promptly.

Key takeaways

Completing the HR 101 V4 form can seem daunting at first, but understanding its purpose and processes can help ease any concerns.

Employee Setup: This form is essential for new employees and must be forwarded to Personnel Administration.
Block Capitals Required: Fill out the form using block capitals to ensure clarity and prevent misunderstandings.
Sections 1-9: As the employee, you are responsible for completing these sections, providing your personal and employment details.
Next of Kin: Including emergency contact information is vital. Make sure to provide accurate details.
Employment History: Clearly outline your previous employment, especially if it involves public service organizations.
Pension Details: If you are receiving a pension, this section requires you to provide related information.
Bank Details: Ensure you enter accurate banking information for correct payroll processing.
Professional Registration: Only applicable for certain professions, this section must be completed if it’s relevant to you.
Employee Declaration: By signing, you confirm the accuracy of your information and agree to update your employer on any changes.

Filling out the HR 101 V4 form diligently will not only help facilitate your employment process but also establish clear communication with your new employer. Keep a copy for your records as a reference to ensure all details are accurate and up-to-date.

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