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Forms

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Application Forms
Employment Forms
Benefits Forms

APPLICATION FORMS

Application for Employment (MS Word Format with editable fields. To place an "x" in boxes, double-click on the box for further instructions.)
Application for Employment - Part B (if applicable; MS Word Format with editable fields. To place an "x" in boxes, double-click on the box for further instructions.)
Application for Employment - Part C (MS Word Format with editable fields. To place an "x" in boxes, double-click on the box for further instructions.)

EMPLOYMENT FORMS

Address Change Form
Confidentiality and Technology Use Agreement (PDF Format)
Employment Eligibility Verification
Foreign National Information Form
W-4 (Federal Tax Withholding)
Form VA-4 (Virginia State Tax Withholding)
Volunteer Acknowledgement and Agreement

BENEFITS FORMS

Health Insurance:

Enrollment/Change Form (Adobe pdf)
Medical Benefit Claim Form (Adobe pdf)
Waiver of Coverage Form (Adobe pdf)
Caremark Prescription Order Form (Adobe pdf)
Caremark RX Reimbursement Form (Adobe pdf)

Dental Insurance:

Enrollment/Change Form (Adobe pdf)
Dental Claim Form (Adobe pdf)

Flexible Spending Accounts:

Flexible Spending Account Claim Form (Adobe pdf)

Life Insurance:

Group Life Insurance Enrollment/Change Form (Adobe pdf)
Group Life Insurance Claim Form (Adobe pdf)
Group Life Portability Insurance Application (Adobe pdf)
Voluntary Life Beneficiary Change Form (Adobe pdf)

Disability:

Employee Request for Accommodation of Disability: Americans with Disabilities Act (MS Word)
Short Term Disability Claim Packet (Adobe pdf)
Employee Claim Forms for Long Term Disability (Adobe pdf)

Domestic Partner Benefits:

Declaration of Domestic Partnership (MS Word)
Declaration of Termination of Domestic Partnership (MS Word)

Workers' Compensation:

Employer's Accident Report (Adobe pdf)
Treatment Acknowledgement Form (Adobe pdf)

Retirement

Participation Authorization and Salary Reduction Agreement (Adobe pdf)