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

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

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

2022 FSA Enrollment Form (PDF)

2022 FSA Enrollment Form

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)