Human Resources Forms

Instructions: All forms in PDF Format, unless otherwise noted.
Print a blank form and fill it in manually, or download the file to your desktop and complete as a Word document.

Please forward all completed forms to the Human Resources Department.

Dental and Health Insurance

• Health Insurance Premium Subsidy (PDF, Word)
• Blue Cross/Blue Shield Enrollment & Change

Domestic Partner

• Affidavit
• Termination Request

Employee Info/ Employment

• Computer Loan Application Form (Sample)
• Demographic Change Form
• Employment Application
• EEO Information Request
• Employee Conference
• Staff Leave Donation Form and Policy

Flexible Spending

• Direct Deposit (Word)
• Enrollment (Word)
• Dependent Care Worksheet (Word)
• Health Care Worksheet (Word)
• Reimbursement (Word)
• Accounts Booklet 2010 (Word)
• Qualified Status Change Event (Word)
• Notice of Continuation of Benefits (Word)

Payroll

• Direct Deposit
• OneCard Authorization
• Federal Tax (W4)
• Massachusetts State Tax (M4)
• Federal Employment Eligibility (I9)
  Spanish I9 (for reference only)
• Personnel Action Form
  

Performance Management

• Community Reference Guide
• Evaluation - Narrative
• Evaluation - Original (Word)
• Revised Simplified (Word)

Retirement & Life Insurance

• Cash Balance Retirement Plan Enrollment
• Salary Reduction / Deduction Agreement
• Life & LTD Election

• Job Analysis (Word)
• Salary Grade Range Chart

• Direct Deposit
• Direct Deposit Cancellation
• Timesheets (view only)
  Instructions

• Employee Reimbursement
• Exchange Application (Word)
• Exchange Recertification
• Grant Application (Word)
• Waiver Application (Word)

• Employer's First Report of Injury or Fatality- Form 101
• Supervisor's Accident Investigation Report (PDF, Word)
  Note: This form documents the supervisor's investigation and needs to be submitted after the investigation is complete and within 7 calendar days of the accident.
• Medical Release
• Medical Treatment