Benefit Forms

Employee Benefit Record Form (enrollment form) (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 Pre-Retirement Catch-Up Form (PDF)

457 Deferred Compensation Age 50 Catch-Up Change Form 2024 (PDF)

CalPERS Address Change Form (PDF)

CalPERS Affidavit of Parent Child Relationship form (PDF)

CalPERS Questionnaire & Medical Report For Disabled Dependent (PDF)

CalPERS Authorization To Disclose Health Information (PDF)

CalPERS Reciprocal Self-Certification Form (PDF)

Commuter Benefits Program (PDF)

Domestic Partner Imputed Income Declaration (PDF)

2024 Flexible Spending Account (FSA) Enrollment Form (PDF)

2024 Flexible Spending Account (FSA) Enrollment Form

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)