Employee Forms

General Employee Forms

Address Change PDF
Email Set Up Form PDF
Check Request PDF
Converting Vacation Leave 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 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 Word Document
Application for Leave PDF
Employee Application for Family or Medical Leave Word Document
Certification of Health Care Provider (FMLA) PDF

Federal Forms

I-9 PDF
W-4 PDF
SSA-1945 PDF

Blue Cross Forms

2008-2009 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

2006-2007 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
(For employees hired after 07/01/06)
PDF

Supplemental Group Insurance

AFLAC Accidental Injury Claim Form PDF
AFLAC Sickness Claim Form PDF
AFLAC Cancellation Notice
This form can only be used during open enrollment.
PDF

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
Phone: (907) 747-1816  Fax: (907) 747-7403
Email: markd@cityofsitka.com
Contact the Webmaster
City and Borough of Sitka, 100 Lincoln St. Sitka, AK 99835 (907)747-3294