Forms

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(If necessary)

Personnel Action Request (PAR)

Special Pay Justification Form

Time Log for Non-Exempt Employees

Health

 Evidence of Insurability

Health and Dependent Care Reimbursement Claim Form

 Other ERS forms

 

Dental

            Cigna Claim Form

 
Life

 Beneficiary Form

Retirement

            Change of Carrier Form

Tax Sheltered Annuity Form

Payroll

Pay Out Option

Link  to Payroll at the site for the forms below:

            Direct Deposit

            2004 W-4 (from IRS)

 

Worker’s Compensation:

            Supervisor’s Accident Investigation

            Nurse’s Injury Report