You are about to fill out a form for U.S Team Members. If you are a Canadian Team Member, please click here and it will redirect you to the right form! :)

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* 1. Your Full Name

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* 2. Last 4 of your SSN 

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* 3. How did you hear about the Team Member Hardship Fund?

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* 4. What business unit do you belong to? (Check one)

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* 5. What Stericycle location do you belong to (City, State)?

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* 6. Your Team Member ID # (If you are a new hire, type "new hire" in box)

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* 7. If you are a new hire, what is your anticipated hire date? (N/A if you are not a new hire)

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* 8. Your Email

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* 9. Would you like to enroll, change your current rate, or opt- out?

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* 10. Please enter your contribution amount (whole number, minimum $1 for donations. If opting out, please enter N/A)

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* 11. By clicking "I agree", I authorize the Stericycle Culture Department to complete this Team Member Hardship Fund Donation Form request on my behalf. I also understand that my elected contribution amount will be processed as an automatic recurring payroll deduction.

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