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. OPEN ENROLLMENT PRESENTATION 22-0101 Final Draft
  2. Blood Screening Consent Form (PDF)
  3. Dental Verification for Incentive (PDF)
  4. Flexible Spending Account Enrollment (PDF)
  5. Flu Shot Consent Form (PDF)
  6. Flu Shot Verification for Incentive (PDF)
  7. Health Insurance Enrollment Form (PDF)
  8. Health Savings Account Authorization Form (PDF)
  9. Health Savings Account Deduction Form (PDF)
  10. Insurance Termination Notice (PDF)
  11. Physical Verification for Incentive (PDF)
  12. Registration Form - Blood Screening and Physical (PDF)
  13. Spouse Coverage Form (PDF)

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. Employee Assistance Program (EAP) (ProMedica) (PDF)
  4. 2022 CCAO Online Enrollment Instructions

CORSA

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