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New Hire Forms

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Description of Form or Document Explanation
I-9 Verify Required Forms of Identification Revised 6-05-07
W-4 For the Current Year
Oath of Office Form 2015-82
Policy Acknowledgement Form

Employee Conduct/Behavior Expectation Policies		 Revised 7-3-07
Stanislaus County NON-DOT Drug Passport Revised 5-07
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
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 (Visual Sample Only) FORM 1012-37 Available From Central Services

Risk Management

Description of Form or Document Explanation
Facts About Workers Compensation Benefits - Brochure From State of California Revised 12-06
Medical Provider Network Brochure Revised 9-5-06 Twenty Page Brochure From RMD
Acknowledgement Form Confirming Receipt of WC and MPN Brochures Memo Dated 7-19-06
PRE-Placement / Physical Ability Testing Revised 4-4-07
PRE-Placement / Ergonomic Screening and Training Revised 4-4-07
PRE-Placement / Audio-Metric Screening See Required Job Class Listing

Benefits - Full Time Employee

Description of Form or Document Explanation
Benefit Enrollment Form - Choose the Appropriate Form Based Upon The Bargaining Unit PO1,PO2,PO3,PO4,PO5,PO6,PO7,PO8,
PO12,PO13
Universal Enrollment / Change Form Revised 12-06
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 and 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

Retirement

Description of Form or Document Explanation
Retirement Member Enrollment Form Revised 3-07 Attach Copy of Birth Certificate
Notice to Prospective Members FORM 415 Revised 12-07
Beneficiary Designation Form Revised 6-07
Termination of Employment Notice to Retirement Board Revised 6-07

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 Catastrophic Application Form Revised 11/04
Donated Time Eligiblity form Revised 9/07
 
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