|
SUPERVISORY FORMS |
|
Pay-4-Performance |
Pay-4-Performance Page and Training Schedule
(Personnel Rule Chapter 3 - PR-304) |
|
Personal Action Form (PAF) |
PAF [Word Doc]
PAF [PDF] |
|
New Hire - Employee Eligibility Verification I-9 - 1 Form [PDF] |
|
New Hire - Orientation Information - 1 Form [PDF] (information required from new employee at orientation) |
|
Recruitment & Selection Process and Forms (for more information outside the YUMA County Intraweb contact Human Resources) |
|
Requisition for Open Position |
Request Form [Word Doc]
Request Form [PDF] |
|
Reallocation of position, Reclassification of position [PDF] - see YUMA County Rules & Regulations or contact Human Resources |
| Voluntary Grade Decrease Request |
Voluntary Grade Decrease Request Form [Word Doc] |
|
Vacancy Review Memo [PDF] |
Vacancy Review Policy [PDF] |
|
Workplace Posters |
Posters required by Arizona
Posters required by U.S. Department of Labor |
|
EMPLOYEE FORMS (used by all employees) |
|
Colonial Supplemental Insurance
2 Forms |
Claim Form and Instructions [PDF]
Request for Service Authorization Form [PDF] |
|
Employee Assistance Program (EAP) |
Connect for EAP Horizon Health Care Services
or call Benefits Administration (928) 373-1165 |
|
Employee Extended Illness Bank (EIB)
CHAPTER IV (BENEFITS) PR-417
1 Document & 2 Forms |
EIB Rule Document (PR-417) [PDF]
Donation Form [PDF]
Application Form [PDF] |
|
Employee Tuition Reimbursement Program
CHAPTER IV (BENEFITS) PR-419
1 Document & 1 Form |
Tuition Reimbursement Rule Document and Form (PR-419) [PDF] |
|
Family Medical Leave (FMLA) |
Yuma County FMLA forms and information |
|
Flexible Spending Account (FSA)
2 Forms |
FSA Health Care Reimbursement Claim Form
FSA Dependent Care Reimbursement Claim Form |
|
SSA Mexico Network (YCEBT PPO)
2 Forms |
SSA English Form [PDF]
SSA Spanish Form [PDF] |
|
PERSONAL INFORMATION FORMS |
|
Change of Address or Name
1 Document & 2 Forms |
Address or Name Change Procedure [PDF]
Address Change Form [PDF]
(Please see Procedure for other required forms)
Name Change Forms
(Please call Human Resources 928-373-1013) |
|
Dental Insurance Forms |
Dental Insurance Forms (Contact Human Resources Benefits) |
|
Direct Deposit - 1 Form |
Direct Deposit Form [PDF] |
|
Retirement (Change in Address, Name, Beneficiary. etc.)
5 Forms |
Arizona State Retirement Forms (ASRS) (online forms)
Correction Retirement (CORP) (online forms)
Court Corrections Officer Retirement (ACORP) (Please call Human Resources 928-373-1013)
Public Safety Retirement (PSRS) (online forms)
Elected Official Retirement (EORS) (online forms) |
|
Federal Tax Forms
1 Forms |
(Required for any change in name, status, dependents, etc.)
Federal Tax Form - W4 PDF] |
Arizona State Tax Form (New)
1 Form |
State Tax Form - A4 Instructions [PDF]
State Tax Form - A4 (effective July 1, 2010) [PDF] |
|
"Section 125" Contribution Account Plan - 1 Form |
Post-tax or Pre-tax Enrollment Form [PDF] |
|
YUMA County Vision Plan (VSP) - 1 Form |
VSP Enrollment / Change Form [PDF] |
YCEBT Insurance - (Yuma County Employee Benefit Trust)
2 Forms
|
YCEBT Enrollment Form (Yuma County MMSI Medical Insurance) [PDF]
MMSI Change of Status (Change of Address) [PDF] |
YCEBT Life Insurance
2 Forms
|
Beneficiary Change Form [PDF]
Change in Status Enrollment Form [PDF] |
|
YCEBT Additional Benefit Information |
Contact Human Resources [PDF] |
|
OTHER FORMS |
|
Employment |
Job Application [PDF]
Job Application [Word Doc] |
|
Relocation - Chapter II (Employment) PR-209) - 1 Form |
Relocation Form |
|
Request for Verification or Public Records |
Please contact Human Resources at 928-373-1113 |
|
Review Personnel File - 1 Form |
Request Form [PDF] |
|
Separation Information - 1 Form |
Exit Interview Form [PDF] |
|
GRIEVANCE/DISCIPLINARY ACTION FORMS - CHAPTER VIII [PDF] |
Grievance Forms [PDF]
Flow Chart [PDF] |
|
Disciplinary Forms [PDF]
Flow Chart [PDF]
OTHER FORMS please refer to Human Resources Office |
|
|
Exit Interview form - please see your immediate Supervisor or contact Human Resources - your Opinion counts. |