Human Resources

ADVENTIST RETIREMENT
   Alternative Beneficiary Designation Form
   AIG Assurance Letter
   Broadcast Pre-Retirement
   Salary Reduction Agreement & Beneficiary Designation Form

AFLAC FORMS
Claim Forms:  mail ATTN: Claims Dept; 1932 Wynnton Rd, Columbus, GA 31999-7251 or fax to 877-442-3522
   Accident
   Cancer
   Continuing Disability
   Initial Disability
   Sickness
   Specified Health Event


Flexone - Flexible Spending Account (FSA)
   Flexone Request for Reimbursement for Medical and/or Dependant Care FSA
   Direct Deposit Option
   Salary Redirection Agreement


Policies
   Accident Application
   Accident Brochure
   Accident Policy Price
   Cancer Application
   Cancer Brochure Level 1
   Cancer Brochure Level 3
   Cancer Level 1 and 3 Price
   Short Term Disability Application
   Short Term Disability Brochure
   Short Term Disability < 39K Price
   Short Term Disability > than 39K Price
   Specified Health Application
   Specified Health Brochure
   Specified Health Price


Wellness Claim Forms:
   Accident
   Cancer
   Hospital Indemnity

EMPLOYMENT
   Application, Non-Education
   Application, Education (Teachers and Principals)
   Automobile Insurance Assistance Policy
   Background Check Authorization for Employment
   Employment Eligibility Verification and Instructions (I9) 
   Employee's Withholding Allowance Certificate (W4)
   New Employee Data Collection
   Pastor Travel Request  (this form is to be submitted to the President's Office for processing)
   Personnel Action Request (P.A.R.)
   Service Record Request
   Travel and Expense Report
   Vacation Application (Exempt Employees)
  

AMERICAN SPECIALTY HEALTH NETWORK (ASHN) (Chiropractic Care)
   Enrollment Application


FITNESS FOR LIFE

   Activity Log
   Aerobic Mile Conversion Chart
   Employee Wellness Participation Plan and Application

HARTFORD
   Accidental Death and Dismemberment (AD&D)
      Enrollment Application
      AD&D Highlights Sheet
      Enrollment Card for Conversion
   Basic Life Insurance
      Basic Life Worksheet
      Beneficiary Designation
      IRS Rate Chart
      Life Insurance Waiver
   Supplemental Life
      Application for Portability of Group Life Insurance Benefits
      Enrollment Application
      Life Conversations
      Life Highlights Sheet
      Notice of Conversion Privileges
      Personal Health Application
      Retiree Life Insurance Enrollment

HCAP (Health Care Assistance Plan)
   Enrollment Application
   Opt Out
   Reimbursement Request
   PPO Providers
   Schedule of Benefits
   Spouse Eligibility and Dependent Eligibility Worksheet
   Spouse Eligibility, Determination by Zone
   Student Certification Forms
      Dependent Child Intention to Return to Full-time Educational Status
      Dependent Child Medical Condition
      Dependent Child Volunteer Service
      Full-time Student Verification Form for Dependent Child

KAISER - Medical and Mental Health Insurance
    Enrollment Application
    Change Form


PACIFICARE POS - Medical and Mental Health Insurance
   Enrollment Application
   Change Form

VALIC - See ADVENTIST REITREMENT listed above

WORKERS COMPENSATION
   Employer's Report Occupational Injry or Illness - 5020
   Employee's Claim for Workers' Compensation Benefits - DWC-1

 

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