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New Hire Forms

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Description of Form or Document Explanation
I-9 Verify Required Forms of Identification Effective 2/02/09
W-4 For the Current Year
Oath of Office Form 2015-82
Policy Acknowledgement Form

Employee Conduct/Behavior Expectation Policies		 Revised 6/09
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 (Visual Sample Only) FORM 1012-37 Available From Central Services

Risk Management

Select Appropriate Department

Description of Form or Document Explanation
Medical Provider Network Brochure Revised 01-01-09 Twenty Page Brochure From RMD
Acknowledgement Form Confirming Receipt of WC and MPN Brochures Memo Dated 7-19-06
PRE-Placement Testing Plan Overview 7-31-08
PRE-Placement / Physical Ability Testing (Kaiser) Select department using dropdown menu
PRE-Placement / Ergonomic Screening (Kaiser) Select department using dropdown 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 FMLA January 2009
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
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 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 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 7-08 Attach Copy of Birth Certificate
Notice to Prospective Members FORM 415 Revised 7-08
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 Catastrophic Application Form Revised 11/04
Donated Time Eligiblity form Revised 9/07
 
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