Employee Downloadable Forms

The following forms are word templates, (except where noted), and are available for employee and management use.  Click on the link below to download or open on your computer.  Forms are being updated & added weekly--check back regularly for the most current version.

Application Forms

• Application Packet --Word Document (Includes application form, background & MVR check disclosures, and Affirmative Action & veteran status form)  This packet is also available in PDF file format.
• In-House Request for Transfer (Current Employees)

Benefit Forms

• 403b Enrollment/Change Form and Web/Interactive Voice Response System  Directions
• Flexible Spending Claim Form (Processed by RPS--scanned copy.  Print and submit to address on form.)
• Leave of Absence Request Form (For all types of leaves including FMLA, personal & military leaves)
• PTO Donation Program:
  Donation of PTO (to donate PTO to another employee)
  Request for PTO Donation (employee to manager for approval)
• PTO Request Form (to request time off for vacation, etc.)
• Referral Bonus Form
• Tuition Reimbursement Form

FMLA (Family Medical Leave Forms)

• Leave of Absence Request Form (30 days notice)
• Certification of Health Care Provider Form (at Agency or management request)
• Employee Appointment/Change Form (submit one to initiate the leave and one to return the employee from leave)
• Timesheet (submit to Payroll regularly)

Human Resource Forms

• Employee Appointment/Change Form
• Employee Discussion Form
• Employee Performance Review Forms
• Job Description Format
• Job Posting Requisition (For Posting job vacancies)
• Reference Check Form (A tool for hiring managers)
• Reference-Verification of Employment (Simplified employment check for companies with policies to "Verify Employment Only")
• Reference-FAX version of the Verification of Employment (contains an applicant release)

New Hire Forms
Offers may be made after the vacancy has been posted a minimum of 3 working days, and are contingent upon screenings (reference, drug, background, MVR, & physical if applicable).  Work with the Recruiter to compile a packet on the new hire before the scheduled orientation/start date.

• Employee Appointment/Change Form (completed by the hiring manager -- acquire all appropriate signatures and submit to HR before the new hire orientation)
• Employee Equipment/Software Request Form  (manager request for employee logins, hardware, e-mail & voicemail) -- submit directly to IS

Payroll Forms

• Direct Deposit
• Not-At-Home Approval Form
• Overload & Special Earnings Form
• Payroll Advance Request Form

TIMESHEETS
Due to manager Monday the week before payroll.
1)  Biweekly Timesheet for Office Personnel (Non-Caregiver)
2)  Biweekly Timesheet for Caregivers
3)  HIV Program Timesheet
4)  Wellness Program Timesheet
5)  Employees on laptop or telephony must log or dial in hours within 48 hours of service.

Performance Review Forms

• Certified Nurses Aide (CNA)
• Flu Shot Program (includes a termination section--due December 31 or at temporary employment end)
• Flu Shot Nurses
• Flu Shot Clerks
• General (Non-Management)
• LPN -- Includes Annual Review of Equipment
• Management/Supervisory
• Medical Social Worker (MSW)
• PCP/Homemaker
• RN, Intermittent -- Includes Annual Review of Equipment
• Therapists (OT, PT, and ST)
• Wellness RNs

Termination Forms
Compile and submit to HR as soon as you are notified/know of a pending termination.  For the Flu Shot Program, please complete the special combined review and termination form.

• Notice of Voluntary Termination (if resignation letter isn't submitted)
• Employee Appointment/Change Form (complete termination section)
• Termination/Resignation Check List
• Exit Interview Form (Schedule the exit interview, x5342, preferably before the last day of work)
  
  If you're going to refill the position, it must be posted for a minimum of 3-working days:
• Job Posting Requisition

Workers' Compensation Forms

• Employee Incident Report (to be completed by any employee with an on-the-job accident or injury)
• Motor Vehicle Accident Report (attach a copy of the police report)
• Witness Statement to an on-the-job incident

Other Forms

• Address Change Form
• Bright Idea Form  (Employee Suggestions)
• Check Request Form
• Emergency Contact Change Form
• Employee Equipment/Software Request (IS Setup or Change)
• Facility Work Order Request
• Fax Cover Sheet
• Office Supply Requisition
• Purchasing Requisition
• Travel Advance Request Form
• Volunteer Approval & Discontinuation Form (Employee request to volunteer or to discontinue volunteering)
• Volunteer Referral & Care Plan