Human Resources Forms

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	Employment Application
	I-9 Documentation
	External Employment and Consulting Application and Approval Form
	Confidential Release Form (Background Check)
	Request To Fill Vacant Position Form

	New Employee Benefit Enrollment
	Beneficiary Designation
	Medicare Coordination Acknowledgement
	ORP Information Acknowledgement
	Dependent Enrollment/Certification
	Benefit Change
	Retiree Benefit
	Survivor Health/Dental/Vision Continuation
	Annual Enrollment
	Retirement Programs
	PayFlex claim Form
	Employee Change of Address
Optional Accidental Death & Dismemberment Forms
	The Hartford Group Life and/or AD&D Claim (Waiver/Paralysis/PTD Package)
	The Hartford Conversion Enrollment for AD&D
Long-Term Claim Forms
	CNA - Long Term Short (For employees and their spouse)
	CNA - Long Term Care Long (For employees parents, parents-in-law, grandparents, grandparents-in-law, retirees and their spouses)
Life Insurance
	Life Insurance Enrollment
	Fort Dearborn Waiver of Premium/Accelerated Death Benefit (living access benefit)
	Fort Dearborn Claim Form
	Fort Dearborn Application to convert to Group Life Insurance
	Fort Dearborn Application for Portability
	Fort Dearbon Evidence of Insurability
	W-9 Form

	Medical Certification
	Sick Leave Pool
	Sick Leave Pool Acknowledgement Form
	Statement of Previous State Employment
	Employee Clearance

	Employees First Report of Injury or Illness
	Bona Fide Offer of Employment (Early return to work with restrictions)
	Request for Paid Leave (Submit if absent from work for more than three days)
	Employer's Wage Statement
	Supplemental Report of Injury
	Worker's or Beneficiary's Notice of Injury or Occupational Disease & Claim for Compensation

	Employee Performance Evaluation (Word Version)
	Formal Complaint Form

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