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Employment Application

Fill Out the Form Below!

Name(Required)
Address(Required)
Are you over the age of 18?(Required)
Are you legally allowed to work in the U.S.?(Required)
Desired type of employment(Required)
Are you able to work weekends?(Required)
Highest level of education received(Required)
Max. file size: 1 GB.
Upload your resume here

Request Employment Verification

Fill out the form below

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Address Change

Change your address by filling out the form below:

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New Address

Personal Info and w-4 Upload

Company Holidays (Office Closed)

  • New Years Day
  • Easter
  • Memorial Day
  • Independence Day
  • Labor Day
  • Thanksgiving
  • Christmas Day

$250 Employee Healthcare Benefit

For information regarding your $250 EE healthcare benefit and how to use, please contact Emily Walters who will assist you through the process. ewalters@newkingdomhealthcare.com

W-4 Forms

If you need to download and print the W-4 forms, please click here to view and print.

https://www.irs.gov/pub/irs-pdf/fw4.pdf

https://www.revenue.state.mn.us/sites/default/files/2022-01/w-4mn.pdf

If you have filled out both your Federal and Minnesota W-4 form and are ready to submit, please attach the form now.

Update your W-4 by filling out the form below:

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Click or drag a file to this area to upload.

InterPreter Request

Please Give Two Weeks Notice For Interpreter Request

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Date / Time the Interpreter is Needed

401K Enrollment Form

Please complete the employee sections of the enrollment form found at this link. Click here.

Once you have completed the form, please attach and submit for processing.  You will be notified once your account is setup.

Here are some things to keep in mind:

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Direct Deposit

Use this form to setup or update your Direct Deposit information. Contact Karissa at klucas@newkingdomhealthcare.com with any questions.

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Name of Financial Institution
Account Type
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Name of Financial Institution
Account 2 Type
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Submit W-4 Info

W-4 Forms

If you need to download and print the W-4 forms, please click here to view and print.

https://www.irs.gov/pub/irs-pdf/fw4.pdf

https://www.revenue.state.mn.us/sites/default/files/2022-01/w-4mn.pdf

If you have filled out both your Federal and Minnesota W-4 form and are ready to submit, please attach the form now.

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Click or drag a file to this area to upload.

Payroll Setup Form

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Address

New Hire Request Form

Use this form to make a new hire request. If you have any questions, please contact klucas@newkingdomhealthcare.com.

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Click or drag a file to this area to upload.

Legal

Please describe the situation and submit for Jeffrey to review. If you have questions, please contact Jeffrey at jplombon@newkingdomhealthcare.com

Patient Complaints

Please provide the following information and we will follow up on the complaint. If you have any questions, please contact Karissa Lucas at klucas@newkingdomhealthcare.com

Technical Support Ticket

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Issue / Request Type

Lab Supply Order

Please complete the following information to have your lab supply order processed. If you have any questions, please contact Shelly at skloos@newkingdomhealthcare.com

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Supply Order Request

Please use this form to place a supply order request. Contact Sara at sderhaag@newkingdomhealthcare.com with any questions.

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Maintenance Request

Please provide the following information and Jeffrey will be in touch with you shortly regarding your request.

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Click or drag a file to this area to upload.

Fill Out Your Records Request Below

Fill in all relevant info below and someone from our office will be in touch with you.

Name(Required)
Max. file size: 1 GB.

Fill Out Your Form Request Below

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Name(Required)
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Fill Out Your Billing Request Below

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Name(Required)
Max. file size: 1 GB.