Benefit Forms

Employee Benefit Record Form (enrollment form) (PDF)

Employee Benefit Record Form 2021 (PDF)

Oakland Firefighter Dental Enrollment Form (PDF)

Dental enrollment form for Oakland sworn fire and fire trainees.

Beneficiary Designation Form - 457 Deferred Compensation Plan (PDF)

Beneficiary Designation Form - CalPERS (PDF)

Beneficiary Designation Form - Life Insurance (Hartford) (PDF)

Beneficiary - Designation of Check (PDF)

457 Deferred Compensation Contribution Change Form (PDF)

457 Deferred Compensation Rollover Form (PDF)

457 Deferred Compensation Enrollment Form (PDF)

457 Deferred Compensation Age 50/Pre-Retirement Catch-Up Form (PDF)

Deferred Compensation Age 50 Pre-Retirement Contribution Catch-up Form

457 Deferred Compensation Plan to Plan Transfer (within Mission Square) (PDF)

457 Deferred Compensation Plan to Plan Transfer Form (transfer within Mission Square)

457 Deferred Compensation Direct Transfer Form (PDF)

457 Deferred Compensation Pre-Retirement Catch-Up Form (PDF)

CalPERS Address Change Form (PDF)

CalPERS Affidavit of Parent Child Relationship form (PDF)

CalPERS Medical Report For Disabled Dependent Benefit (PDF)

CalPERS Questionnaire For Disabled Dependent (PDF)

CalPERS Reciprocal Self-Certification Form (PDF)

Commuter Benefits Program (PDF)

2021 FSA Enrollment Form (PDF)

Domestic Partner Imputed Income Declaration (PDF)

Medical Waiver Premium Plan - Cash In Lieu (PDF)

The Club at City Center Payroll Deduction Authorization Form (PDF)

The Club at City Center Payroll Deduction Authorization Form.

Voluntary Life Insurance Enrollment Form (PDF)

DE-4 (PDF)

W-4 (PDF)

Emergency Contact (PDF)

SSA-1945 (PDF)

Predesignation of Personal Physician Form (PDF)

Direct Deposit Form (PDF)