Employee Resources

Documents

Policies

  1. 2021 FINAL rev 05-22

Tax Forms

  1. Local Tax (PDF)
  2. State Tax (PDF)
  3. 2022 W4

Direct Deposit Forms

  1. Authorization for Email (PDF)
  2. Set-Up or Cancel Form (PDF)

Insurance Forms

  1. Member Guide FAQs
  2. Wellness Incentive Info Sheet
  3. Blood Screening Consent Form (PDF)
  4. 2023 Registration - Physical, Blood Screening
  5. 2023 Physical Verification for Incentive (PDF)
  6. 2023 Dental Verification for Incentive (PDF)
  7. 2023 Flu Shot Verification for Incentive (PDF)
  8. Flexible Spending Account Enrollment (PDF)
  9. Health Insurance Enrollment Form (PDF)
  10. Health Savings Account Authorization Form (PDF)
  11. 2023 Health Savings Account Deduction Form (PDF)
  12. 2023 Health Savings Account Procedure
  13. Insurance Termination Notice (PDF)
  14. Wellness Physical Checklist
  15. Registration Form - Blood Screening and Physical (PDF)
  16. Spouse Coverage Form (PDF)
  17. Life Insurance beneficiary form (Mutual of Omaha)
  18. Contact Information

Benefit SBCs for Insurance Plans

  1. PPO
  2. HSA Single
  3. HSA Family

Requests for FMLA

  1. Family and Medical Leave Act (FMLA) - Employee Rights Notice (PDF)
  2. Family and Medical Leave Act (FMLA) - Self (PDF)
  3. Family and Medical Leave Act (FMLA) - Family Member (PDF)

Informational Sheets on Ancillary Benefits

  1. Deferred Compensation - Ohio Deferred Compensation (PDF)
  2. Deferred Compensation - Empower (PDF)
  3. CCAO Deferred Comp Plan-Highlights
  4. Deferred Comp Open Enrollment Instructions - Empower
  5. EAP Poster

CORSA

  1. 2019 CORSA University Access Instructions (PDF)
  2. Accidents and Traffic Citations (PDF)
  3. Report of Accident (PDF)

Other Employee Forms

  1. Employee Injury and Incident Report (PDF)
  2. Leave Request Form (PDF)
  3. Travel Expense Reimbursement Form (PDF)
  4. ID form 2021
  5. Hourly Employee Time Sheets (XLSX)
  6. Internal Employment Application
  7. 2022 IRS Mileage Rate INCREASE memo