Forms
All forms are PDF and open in a new window unless otherwise indicated.
New Employee Packet (Part-Time without Benefits)
Benefit Forms
- Basic Life Insurance Enrollment Form
- Flexible Spending Election Form - pdf
- Flexible Spending Election Form - word
- Flexible Spending Request for Reimbursement Form-pdf (EBMC beginning 7/1/09)
- Flexible Spending Request for Reimbursement Form - word (EBMC beginning 7/1/09)
- Health/Dental Enrollment/Change Form
- Long-Term Disability Enrollment Form
- Mail-Order Rx Drug Order Form
- Optional Life Insurance Enrollment Form
- Retirement Plan Contribution Form
- Retirement Plan Beneficiary Change Form
Forms Used in the Hiring Process
- Temporary Employees Employ/Term
- Search Authorization Form
- Hiring Report I
- Hiring Report II
- Hiring Report III
- Computing Information Form
- Housing Information Form
- Moving Expense Reimbursement Form
- Payroll Distribution Form
- Receipt of Handbook Form
- I-9 Form
- W4 form
- IT-4
- Background Check Authorization Form
FMLA Forms
- Certification of Health Care Provider for Employee's Serious Health Condition
- Certification of Health Care Provider for Family Member's Serious Health Condition
- Notice of Eligibility and Rights & Responsibilities
- Leave Designation Notice
- Certification of Qualification Exigency for Military Family Leave
- Certification for Serious Injury or Illness of Covered Servicemember-for Military Family Leave
Department of Labor FMLA website
Other Forms
- Evaluation Form -- Administrators- pdf
- Evaluation Form - Administrators - word
- Evaluation Form -- Nonexempt Staff- pdf
- Evaluation Form - Nonexempt Staff - word
- Pre-Evaluation Form -- Nonexempt Staff
- Report of Work-Related Incident/Injury
- Work-Related Incident/Injury Claim Procedures
- Position Description Questionnaire Non Exempt Staff-pdf
- Postion Description Questionnaire Non Exempt Staff - word
- Domestic Partner Information and Certification
- Domestic Partner Termination Form
- ING Salary Reduction Agreement