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HR Forms
Click to View and/or Print the Appropriate Form(s):


2017 - 2018 HEALTH BENEFITS ENROLLMENT FORM:  (new)

2017-2018 – Health Benefits Enrollment Form



2017 - 2018  FLEXIBLE SPENDING ACCOUNT:  (new)

2017 - 2018 Flexible Spending Account (FSA) Enrollment Form

2017 - 2018 Flexible Spending Account (FSA) Information Packet



DIRECT DEPOSIT:

Direct Deposit



EMPLOYEE DATA FORM: (new)

Employee Data Form



EMPLOYEE EMERGENCY CONTACT FORM:

Employee Emergency Contact Form 



E-STUBS (Electronic Paystub System):

E-Stubs Request Form 



DISCIPLINARY PROCESS:

Disciplinary Action Report



EAP/REACH:

EAP Reach Pamphlet (new)

EAP Supervisor Referral Form



EXIT PROCESS:

Checkout Process Form 



GRIEVANCE PROCESS:

Grievance Form



FAMILY MEDICAL LEAVE ACT (FMLA):

FMLA Employee Rights and Responsibilities

FMLA Fact Sheet 28

FMLA Certification of Health Care Provider for Employee's Serious Health Condition

FMLA Certification of Health Care Provider for Family Member's Serious Health Condition

FMLA Fact Sheet 28A Military

FMLA Certification for Serious Injury or Illness Covered Servicemember for Military Family Leave

FMLA Certification of Qualifying Exigency for Military Family Leave



LEAVE SHARE PROGRAM:

Leave Share Recipient Application Form

Leave Share Donor Form



OUTSIDE EMPLOYMENT FORM:

Secondary (Outside) Employment Request



PERSONNEL ACTION FORM (PAF):

Personnel Action Form (PAF)



REQUEST TO HIRE FORM:  

Request to Hire / Recruitment Approval Form



SUBSTANCE ABUSE POLICY:


Supervisor Reasonable Suspicion Report Form

Reasonable Suspicion Consent Form



TAX FORMS:

VA-4 Form (State)


W-4 Form (Federal)



TUITION REIMBURSEMENT:

Tuition Reimbursement Form



Return completed form to the "Human Resources Department" unless form indicates alternate recipient.


City of Petersburg - Virginia