OnStaff USA - Employee Benefits: Benefit Request

Employee Benefit Request

You are important to us at OnStaff USA. We appreciate your loyalty and the professional way you represent us. For your convenience, OnStaff USA has consolidated the employee benefits form. For details concerning these requests, please refer to your employee pamphlet.

Only one request per form will be honored.

* indicates a required field

Child Care Reimbursement Request Perfect Attendance Request Vacation Pay Request
Your First & Last Name	*
Your E-mail	*
Your Phone Number	*
Last 4 Digits of Your SSN	*
By clicking submit, I am confirming that all of the information provided above is true and accurate.

5207 Portage Road • Portage, MI 49002 • Tel: 269-385-6292 • Fax: 269-385-8321