Benefit Forms

Documents

Employee Benefit Record Form (enrollment form) (PDF)

Deferred Comp COVID Related Withdrawal Form (PDF)

Deferred Comp COVID Related Loan Suspension Form (PDF)

Employee Certification for Leave Under the Families First CORONAVIRUS RESPONSE ACT (FFCRA) (PDF)

Employee Certification for Leave Under the Families First CORONAVIRUS RESPONSE ACT (FFCRA)

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 2020 (PDF)

457 Deferred Compensation Enrollment Form (PDF)

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

Commuter Benefits Program (PDF)

Domestic Partner Imputed Income Declaration (PDF)

2020 FSA Enrollment Form (PDF)

Medical Waiver Premium Plan - Cash In Lieu (PDF)

Voluntary Life Insurance Enrollment Form (PDF)

DE-4 (PDF)

W-4 (PDF)

Emergency Contact (PDF)

SSA-1945 (PDF)

CalPERS Reciprocal Self-Certification Form (PDF)

Predesignation of Personal Physician Form (PDF)

Direct Deposit Form (PDF)

Deferred Compensation Plan To Plan Transfer Form (PDF)