Human Resources Forms

Human Resources

Dental Insurance

Form NameFile Size
Guardian Dental Coverage115 KB PDF

Flex Spending

Form NameFile Size
Flexible Spending Account Claim Form39 KB PDF
Flexible Spending Enrollment Form97 KB PDF
Flexible Spending Eligible Items35 KB PDF
Medical Expense Planning Worksheet65 KB PDF

Health Insurance

Form NameFile Size
Simply Blue Benefits Summary438 KB PDF
Excellus Medicare Eligibility Form63 KB PDF
Dependent Certification Form119 KB PDF

Life Insurance

Form NameFile Size

MAC HR Office

Form NameFile Size
Employee Emergency Notification Form62 KB PDF
Employee Change of Address Form61 KB PDF
Accident Report100 KB PDF
Tuition Reimbursement Program31 KB PDF
Timesheet17 KB PDF
Direct Deposit Authorization Form37 KB PDF
Employee Emergency Contact Information72 KB PDF

Payroll and Tax Forms

Form NameFile Size
I-9 Employment Eligibility Verification
2011 IT-2104 State Filing468 KB PDF
2012 W-4109 KB PDF
2012 Payroll Calendar78 KB PDF

Retirement

Form NameFile Size

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