Pocantico Hills CSD - Human Resources Forms (Staff Only)

- Plan List of Benefits
- FSA Form
- Health Insurance Enrollment Transaction Form
- Pre-Tax Form - Health Insurance
- Health Insurance Enrollment/Declination Form
- Life Insurance - JJStanis
  - Request for Change of Beneficiary Form
- 403(b)
- Cancer Screening Leave Form
- Universal Enrollment Form
  - Name Change Form
- Sunrise Dental Plan
- Sunrise Dental Enrollment Plan
- Gold Vision Plan
- FMLA Employee Rights and Responsibilities
- FMLA Employee Guide
- FMLA Leave Request Form
  - Certification of Health Care Provider for Family Member's Serious Condition (Form WH-380-F)
  - Certification of Health Care Provider for Employee's Serious Condition (Form WH-380-E)
  - Certification of Qualifying Exigency for Military Family Leave (Form WH-384)
  - Certification of Serious Injury or Illness of Covered Service Member for Military Leave (Form WH-385)
- NYSLRS - ERS Membership Form
- ERS Prior Membership
- NYSTRS Membership Form
- NYSTRS Prior Membership Form
- I-9
- W-4
- IT-2104
- Direct Deposit
- Number of Pays per Year - 10 Month Employees