International Employee Benefits Enrollment
Personal Information
First Name
Last Name
Date of Birth
Nationality
Email
Phone Number
Home Country Address
Host Country Location
Employment Details
Employee ID
Job Title
Department
Start Date
Work Contract Type
Full-Time
Part-Time
Contractor
Intern
Benefits Enrollment
Medical Insurance Plan
International Basic
International Plus
Local Plan
Dental Insurance
Included
Not Included
Vision Insurance
Included
Not Included
Life & Disability Insurance
Yes
No
Pension/Retirement Plan
Yes
No
Dependent Information
List Dependents (Name, Relationship, Date of Birth)
Additional Notes
Special Requirements or Comments