Employee Forms
General Employee Forms
- Address Change (PDF)
- Email Set Up Form (PDF)
- Check Request (PDF)
- Converting Vacation Leave to Cash (PDF)
- Converting Personal Leave (PTO) to Cash (PDF)
- Direct Deposit (PDF)
- Evaluation Forms for Supervisors (Word Template)
- Filling a Position Temporarily (Word Document)
- Salaried Exception Report (Excel Document)
- Travel Request (Publisher)
- Travel Request (PDF)
Occupational Injury
- OSHA Form 301 - Injuries and Illnesses Incident Report (PDF)
- How to fill out an Occupational Injury Report (PDF)
Leave Forms
- Application for Leave (PDF)
- ASEA Leave Form (PDF)
- PSEA Application for Leave (PDF)
- Employee Application for Family or Medical Leave (Word Document)
- Certification of Health Care Provider (FMLA) (PDF)
Federal Forms
Blue Cross Forms
- 2009-2010 Premium Card (Price Sheet) (PDF)
- Enrollment and Change Application Form (PDF)
- Medical - Dental - Vision Claim Form (PDF)
- Prescription Drug Reimbursement Form (PDF) (Blue Cross Site)
- Blue Cross Member Claim Form (PDF) (Blue Cross Site)
- Premera Student Status Verification (PDF)
SBS Forms
- 2008-2009 Premium Card (Price Sheet) (PDF)
- Beneficiary Designation (PDF)
- Annuity Benefit Payment Election Form (PDF)
- Enrollment Guide (PDF)
- Enrollment Instructions (PDF)
- Enrollment Worksheet (PDF)
PERS
- PERS Plan Comparison Chart (Tiers I-IV) (PDF)
- Beneficiary Designation Form (PDF)
- Beneficiary Designation Form (PDF) (For employees hired after 07/01/06)
Supplemental Group Insurance
- AFLAC Accidental Injury Claim Form (PDF)
- AFLAC Sickness Claim Form (PDF)
- AFLAC Cancellation Notice (PDF) This form can only be used during open enrollment.
ICMA Deferred Compensation 457b Plans
- ICMA Amount of Deferral Change Form (PDF)
- ICMA Employee Enrollment Form (PDF)
- ICMA Employee Information Change Form (PDF)
Great West Governmental 457b Plans
- Salary Deferral Agreement (PDF)
- Beneficiary Designation (PDF)
- Incoming Transfer/Direct Rollover (PDF)
Group Life Insurance
- Lifewise Beneficiary Change Form (PDF)
- Lifewise Group Insurance Enrollment (PDF)
- Lifewise Voluntary Life Enrollment Form (PDF)
Mark Danielson, SPHR, Human Resources Director
(907) 747-1816 Fax: (907) 747-1846
markd@cityofsitka.com