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Human Resources Forms

TOPS® Centers for Medicare and Medicaid Services (CMS) Forms without Sensor Bar #CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits.  >>More..

TOPS® Centers for Medicare and Medicaid Services (CMS) Forms without Sensor Bar #CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits.  >>More..

TOPS® UB04 Hospital Insurance Claim Form For filing claims with patients' insurance carriers.  >>More..

TOPS® UB04 Hospital Insurance Claim Form For filing claims with patients' insurance carriers.  >>More..

TOPS® Business Forms Employee Record Master File Jacket Record and update employment history.  >>More..

TOPS® Business Forms Employee Record Master File Jacket Record and update employment history.  >>More..

TOPS® Business Forms Employee`s Record File Folder Update employee history and status on front, confidential material on back.  >>More..

TOPS® Employee Application Form Employment history, references, education, personal information, physical record and check-offs for special questions.  >>More..

TOPS® Comprehensive Employee Application Form The most comprehensive inquiry into a candidate's history: past employment, references, education, personal information and check-offs for special questions.  >>More..

TOPS® Daily Attendance Card A control for raises, union disputes and vacation scheduling.  >>More..

TOPS® Employee Status Report Documents a change in employee status and the reason for the change.  >>More..

Universal™ Pay Envelopes Shows hours worked, amount earned, deduction listing (including Medicare) and net amount.  >>More..

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Payroll And Personnel Record Books

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800-969-5397

DOME PUBLISHING COMPANY

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Bookkeeping Records Record of Cash Received and Paid Out. Includes Net Profit, Net Worth, Payroll. Undated-start anytime. 128 pages, wirebound.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	DOM612 Check Stock		Monthly/Tan Cover	11 x 8-1/2	Each	$12.65	$9.04	29%
	DOM600 Check Stock		Weekly/Brown Cover	11 x 8-1/2	Each	$12.65	$9.04	29%

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Payroll Records Weekly format. Seven deduction columns. Includes Calendar of Tax Form Due Dates, Schedule of Payroll Deposits, Explanation of Payroll Tax Forms. Monthly, quarterly and yearly summaries. Blue. Wirebound covers.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	DOM710 Check Stock		1-15 Employees	7-1/2 x 10-1/2	Each	$8.70	$6.41	26%
Single Entry System
	DOM650 Check Stock		1-50 Employees	11-1/4 x 8-3/4	Each	$12.65	$9.04	29%

ESSELTE PENDAFLEX CORP.

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Pendaflex® Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
Hanging Style with Pivoting Hangers
	ESSSER2BL Check Stock			Blue	Each	$15.04	$11.61	23%
	ESSSER2BL-CTN Check Stock			Blue	Carton of 10 EA	$123.00	$90.07 (9.01/ea)	27%
	ESSSER2GR Check Stock			Green	Each	$15.04	$11.61	23%
	ESSSER2ER Check Stock		Hanging Personnel Folders, 1/3 Cut, Top Tab, Letter, Red, 10/box		Each	$15.04	$11.61	23%
	ESSSER2YEL Check Stock			Yellow	Each	$15.04	$11.61	23%
Vertical Style
	ESSSER1BL Check Stock			Blue	Each	$13.46	$9.68	28%
	ESSSER1GR Check Stock			Green	Each	$13.46	$9.68	28%
	ESSSER1ER Check Stock		Vertical Personnel Folders, 1/3 Cut, Top Tab, Letter, Red, 10/box		Each	$13.46	$9.68	28%
	ESSSER1YEL Check Stock			Yellow	Each	$13.46	$9.68	28%
	ESSSER1YEL-CTN Check Stock			Yellow	Carton of 50 EA	$551.00	$395.92 (7.92/ea)	28%

QUALITY PARK PRODUCTS

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Quality Park™ Employee Record Jacket Complete record of payroll, personnel, employment, accident and termination on outside. Closed sides. Full cut tab for employee's name. Manila stock.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	QUA69999 Check Stock		100 Jackets per Box	9-1/2 x 11-3/4	Box of 1 C	$91.66	$74.64	19%

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Quality Park™ Employee Record Folder Complies with Americans with Disabilities Act (ADA) requirements and EEO-1 information. Complete payroll, personnel, employment, accident and termination record on outside. Full cut tab for employee's name. Manila stock. Americans with Disabilities Act Requirement: ". . .information obtained regarding the medical condition or history of an individual is to be collected and maintained on separate forms and in separate medical files and is to be treated as a confidential medical record." Section 102 (c) (3).

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	QUA69998 Check Stock		20 Folders per Pack	9-1/2 x 11-3/4	Pack	$14.95	$12.40	17%

REDIFORM OFFICE PRODUCTS

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Rediform® Employee Application Complete information in an easy-to-understand format. Revised to comply with the Americans with Disabilities Act (ADA). Top punched, printed both sides. 50 sheets per pad with cover. Americans with Disabilities Act Requirement: ". . .information obtained regarding the medical condition or history of an individual is to be collected and maintained on separate forms and in separate medical files and is to be treated as a confidential medical record." Section 102 (c) (3).

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	REDM66026NR Check Stock			8-1/2 x 11	PD	$6.49	$3.95	39%

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Rediform® Two-Part Statement of Earnings Book Bound-in black-print carbonless duplicates keep a permanent record of earnings and deductions of hourly and salaried employees. Statements can be used for any time period. Detached size 3-5/8 x 6-3/8. 50 sets per book.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
	RED4L416 Check Stock		Statement of Earnings/Deductions, 6-3/8 x 3-5/8, 2-Part, 50 Sets/Book		Each	$4.59	$3.01	34%

TOPS BUSINESS FORMS

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TOPS® Centers for Medicare and Medicaid Services (CMS) Forms with Sensor Bar #CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. Top sensor bar for microfiche duplication is required in some states. 20-lb. white paper; OCR red ink for scanning. 8-1/2 x 11.

Order Qty	Item No		Description		Sold By	List Price	Your Price	You Save
Continuous Form
Carbonless duplicate.
	TOP50129R Check Stock		100 Sets per Carton	Two-Part Form	Pack	$23.48	$18.67	20%
	For laser printers.
	TOP50135R Check Stock		250 Sets per Carton	One-Part Form	Pack	$18.40	$12.62	31%

Next Page

Bookkeeping Records Record of Cash Received and Paid Out. Includes Net Profit, Net Worth, Payroll. Undated-start anytime. 128 pages, wirebound. Monthly/Tan Cover 11 x 8-1/2

Item Number DOM612 Global Product Type Ledgers / Journals Ledgers / Journals Type Record Pages Per Book 128 Sheet Size (W x H) 8 1 / 2 in x 11 in Number of Columns 4 Format Monthly, 15 Employees Dated / Undated Undated Numbered / Unnumbered Unnumbered Binding / Cover Type Wirebound / Vinyl Cover Color(s) Tan Cover Material(s) Vinyl Column Headers Net Profit, Payroll, Net Worth, Cash Received-Paid Out

Bookkeeping Records Record of Cash Received and Paid Out. Includes Net Profit, Net Worth, Payroll. Undated-start anytime. 128 pages, wirebound. Weekly/Brown Cover 11 x 8-1/2

Item Number DOM600 Global Product Type Ledgers / Journals Ledgers / Journals Type Record Pages Per Book 128 Sheet Size (W x H) 8 1 / 2 in x 11 in Number of Columns 4 Format Weekly, 15 Employees Dated / Undated Undated Numbered / Unnumbered Unnumbered Binding / Cover Type Wirebound / Vinyl Cover Color(s) Brown Paper Color(s) White Cover Material(s) Vinyl Column Headers Cash Received-Paid Out, Net Profit, Net Worth, Payroll

Payroll Records Weekly format. Seven deduction columns. Includes Calendar of Tax Form Due Dates, Schedule of Payroll Deposits, Explanation of Payroll Tax Forms. Monthly, quarterly and yearly summaries. Blue. Wirebound covers. 1-15 Employees 7-1/2 x 10-1/2

Item Number DOM710 Global Product Type Ledgers / Journals Ledgers / Journals Type Payroll Record Pages Per Book 128 Sheet Size (W x H) 7 in x 10 in Number of Columns 7 Format Weekly Format For Up To 15 Employees, Weekly, with Monthly, Quarterly and Yearly Summaries Dated / Undated Undated Numbered / Unnumbered Unnumbered Binding / Cover Type Wirebound / Vinyl Cover Color(s) Blue Cover Material(s) Vinyl Ledgers / Journals Special Features Perforated Pages Size 7-1 / 2 X 10-1 / 2

Payroll Records Weekly format. Seven deduction columns. Includes Calendar of Tax Form Due Dates, Schedule of Payroll Deposits, Explanation of Payroll Tax Forms. Monthly, quarterly and yearly summaries. Blue. Wirebound covers. Single Entry System One employee per page. 1-50 Employees 11-1/4 x 8-3/4

Item Number DOM650 Global Product Type Ledgers / Journals Ledgers / Journals Type Payroll Record, Single Entry System Pages Per Book 128 Sheet Size (W x H) 8 1 / 2 in x 11 in Number of Columns 7 Format Double-Page Monthly For Up To 50 Employees, Weekly, with Monthly, Quarterly and Yearly Summaries Dated / Undated Undated Numbered / Unnumbered Unnumbered Binding / Cover Type Wirebound / Vinyl Cover Color(s) Blue Paper Color(s) White Cover Material(s) Vinyl Ledgers / Journals Special Features Single Entry System Size 11-1 / 4 X 8-3 / 4

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Hanging Style with Pivoting Hangers Blue

Item Number ESSSER2BL Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Blue Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Hanging Style with Pivoting Hangers Blue

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Hanging Style with Pivoting Hangers Green

Item Number ESSSER2GR Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Green Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Hanging Style with Pivoting Hangers Red

Item Number ESSSER2ER Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Red Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Hanging Style with Pivoting Hangers Yellow

Item Number ESSSER2YEL Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Yellow Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Vertical Style Blue

Item Number ESSSER1BL Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Blue Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Vertical Style Green

Item Number ESSSER1GR Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Green Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Vertical Style Red

Item Number ESSSER1ER Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Red Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Vertical Style Yellow

Item Number ESSSER1YEL Global Product Type File Folders File Folder Type Expanding, Personnel, Top Tab Size Letter Folder Material 20 Pt. Pressguard® Color(s) Yellow Tab Cut 1 / 3 Tab Position Center Expansion 2 in Post-Consumer Recycled Content Percent 25 % Total Recycled Content Percent 25 %

Personnel Folders Classification folder with cut tab in middle position for employee's name. Five Mylar® reinforced tab dividers within folder: Application/Resume, Compensation History, Performance Reviews, Training/Education, Misc./History. 20 pt. PressGuard® covers, specially coated to resist moisture, contain at least 25% post-consumer material. 9-1/2 x 11-3/4. 2" reinforced Tyvek® tape gusset expansion. Vertical Style Yellow

Employee Record Jacket Complete record of payroll, personnel, employment, accident and termination on outside. Closed sides. Full cut tab for employee's name. Manila stock. 100 Jackets per Box 9-1/2 x 11-3/4

Item Number QUA69999 Global Product Type File Jackets / Sleeves / Wallets File Folder Type Employee Record, Jacket Height 9 1 / 2 in Width 11 3 / 4 in Material(s) 11 Pt. Manila Stock Color(s) Manila

Employee Record Folder Complies with Americans with Disabilities Act (ADA) requirements and EEO-1 information. Complete payroll, personnel, employment, accident and termination record on outside. Full cut tab for employee's name. Manila stock. Americans with Disabilities Act Requirement: ". . .information obtained regarding the medical condition or history of an individual is to be collected and maintained on separate forms and in separate medical files and is to be treated as a confidential medical record." Section 102 (c) (3). 20 Folders per Pack 9-1/2 x 11-3/4

Item Number QUA69998 Global Product Type File Folders File Folder Type Personnel, Top Tab Size Letter Folder Material 11 pt. Manila Color(s) Manila

Employee Application Complete information in an easy-to-understand format. Revised to comply with the Americans with Disabilities Act (ADA). Top punched, printed both sides. 50 sheets per pad with cover. Americans with Disabilities Act Requirement: ". . .information obtained regarding the medical condition or history of an individual is to be collected and maintained on separate forms and in separate medical files and is to be treated as a confidential medical record." Section 102 (c) (3). 8-1/2 x 11

Item Number REDM66026NR Form Type Employment Application Global Product Type Forms Format 50-Form Pad Form Size (W x H) 8 1 / 2 in x 11 in Sheet Size (W x H) 8 1 / 2 in x 11 in Principal Heading(s) Application for Employment Layout One Form Continued from Front to Back of Sheet Binding Top Punching Top, Three-Hole Paper Color(s) White Print and Ruling Color(s) Black Pre-Consumer Recycled Content Percent 70 % Post-Consumer Recycled Content Percent 30 % Total Recycled Content Percent 100 %

Two-Part Statement of Earnings Book Bound-in black-print carbonless duplicates keep a permanent record of earnings and deductions of hourly and salaried employees. Statements can be used for any time period. Detached size 3-5/8 x 6-3/8. 50 sets per book.

Item Number RED4L416 Form Type Earnings Statement Global Product Type Forms Format 50-Set Book Form Size (W x H) 6 3 / 8 in x 3 5 / 8 in Principal Heading(s) Statement of Earnings & Deductions Layout One Form on Page Copy Types Black-Print Carbonless Duplicate Binding Side Punching Hanging Hole, Side, Two-Hole Paper Color(s) Blue, Gray, White Print and Ruling Color(s) Black, Blue Copy Paper Color(s) Canary

Centers for Medicare and Medicaid Services (CMS) Forms with Sensor Bar #CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. Top sensor bar for microfiche duplication is required in some states. 20-lb. white paper; OCR red ink for scanning. 8-1/2 x 11. Continuous Form Carbonless duplicate. 100 Sets per Carton Two-Part Form

Item Number TOP50129R Form Type Insurance Claim Global Product Type Forms Format Continuous Form Set Form Size (W x H) 8 1 / 2 in x 11 in Principal Heading(s) 1500 Health Insurance Claim Form Layout One Form per Sheet Copy Types Black Print Carbonless Duplicate Punching Dot Matrix Holes Printer Compatibility Dot Matrix Paper Stock 20-lb. Paper Color(s) White Print and Ruling Color(s) OCR Red

Centers for Medicare and Medicaid Services (CMS) Forms with Sensor Bar #CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. Top sensor bar for microfiche duplication is required in some states. 20-lb. white paper; OCR red ink for scanning. 8-1/2 x 11. Continuous Form For laser printers. 250 Sets per Carton One-Part Form

Item Number TOP50135R Form Type Insurance Claim Global Product Type Forms Format Loose Form Form Size (W x H) 8 1 / 2 in x 11 in Principal Heading(s) 1500 Health Insurance Claim Form Layout One Form per Sheet Printer Compatibility Laser Paper Stock 20-lb. Paper Color(s) White Print and Ruling Color(s) OCR Red

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