Human Resources Forms

Your Title

New Hire Forms

Description of Form or Document	Explanation
I-9 Verify Required Forms of Identification	Expires 08/31/12
W-4	For the Current Year
Oath of Office	Form 2015-82
Policy Acknowledgement Form Employee Conduct/Behavior Expectation Policies	Revised 03/12
Workweek Designation	Fair Labor Standards Act-FLSA Revised 12-04
At-Will Status Acknowledgement Management \| Confidential	Management / Confidential Only
Deputy Oath	For Sworn Job Classifications - County Clerk Form 13
Appointment Above 1st Step or Bottom of Band	Memo When Applicable
Personnel Action Form - PAF	Report is generated from PeopleSoft
LIVESCAN Service - Fingerprint form for Sheriff's Department (Visual Sample Only)	FORM 1012-36 Available from Central Services
Agency Shop Payroll Deduction Form for SCEA, SEIU Unions Exception BU 8 (Visual Sample Only)	FORM 1012-37 Available From Central Services

Risk Management

Select Appropriate Department First Before Clicking Link for Pre-Placement

Description of Form or Document	Explanation
Medical Provider Network Brochure	Revised 12-01-09 Thirteen Page Brochure From RMD
Acknowledgement Form Confirming Receipt of WC and MPN Brochures	Revised 02-23-2012
DWC-Time to Hire Pamphlet	3-1-07
PRE-Placement Testing Plan Overview	7-31-08
PRE-Placement / Physical Ability Testing (Kaiser)	Select department using drop down menu
PRE-Placement / Ergonomic Screening (Kaiser)	Select department using drop down menu
PRE-Placement / Audio-Metric Screening	See Required Job Class Listing
POST-Offer Medical Testing Program Department Instructions	Revised October 2008
Family Medical Leave of Absence Policy	January 2009
Certification of Health Care Provider for Family Leave	10/28/11
Certification for Serious Injury or Illness of a Covered Service Member for Military Family Leave	January 2009
Certification of Qualifying Exigency Military Family Leave	January 2009
Your Rights and Responsibilities under the FMLA	January 2009

Benefits - Full Time Employee

Description of Form or Document	Explanation
Universal Enrollment / Change Form	Revised 10-08
Life Insurance Enrollment Form	Form 47071a-2
Evidence of Insurability - For Additional Life Insurance over $100,000	Form 47228CA
Deferred Compensation - Enrollment packets from Hartford and Diversified. These packets are only distributed in a hard copy format. Available from Risk Management Division - Benefits.	Required for PO1,PO2,PO3,PO6,PO8. Other BU Optional. The Forms Are In The Back Of Packet.
Insurance Waiver & Proof of Other Insurance	Employee Elects to Waive Insurance Coverage

Benefits - Part Time Employee

PARS - Is an Alternative Retirement System for part time, temporary or seasonal employees

Description of Form or Document	Explanation
PARS Designation of Beneficiary Form	Revised 3-05
PARS Plan Information Sheet	Revised 2-13-07
PARS Plan Summary	Revised 9-04
PARS SSA-1945 Cover Letter	Two (2) Copies to the Chief Executive Office
PARS SSA-1945 Notification Form	Two (2) Copies to the Chief Executive Office
PARS Government Pension Offset Information Sheet	Revised 8-04
PARS Windfall Elimination Provision Information Sheet	Revised 3-04

Extra-Help Retired County Employee

Rehiring a Retiree as a Part Time Employee or PSC

Description of Form or Document	Explanation
Rehiring a Retired County Employee Checklist	Revised 05/12

Retirement

Description of Form or Document	Explanation
Retirement Member Enrollment Form	Revised 10-09 Attach Copy of Birth Certificate
Notice to Prospective Members FORM 415	Revised 11-11
Beneficiary Designation Form Instructions for Active Members	New added 7-08
Beneficiary Designation Form	Revised 5-09
Termination of Employment Notice to Retirement Board	Revised 7-08

Exit Interview

Description of Form or Document	Explanation
Exit Interview Process and Form	Revised 04/06/07

Other Forms

Description of Form or Document	Explanation
Voluntary Time Bank Procedures	Final Version distributed January 2008
Employee Donation of Time Form	Revised 7/11
Donated Time Eligibility form	Revised 9/07
For Cause Testing Employee Clinic Passport	Revised 6/11
Ethics Complaint Form	Revised 6/11
Retiree 5% Exempt Form