Forms

The forms below are PDF files that may be viewed and printed with Adobe Acrobat Reader. If you would like a Word version of any form, please contact Human Resources.

Return the forms to the address at the bottom of each form.

Benefits Forms:

COBRA Qualifying Event:

• Notice of a COBRA Qualifying Event

Dependent Tuition:

• Dependent Tuition Reimbursement Request

Dental Plan Forms:

• Delta Dental Claim Form

Flexible Spending Account (FSA) Forms:

• IRS Publication 502 (Flexible Spending Account)
• Go to tasconline.com to process FSA needs for the plan year beginning 1/1/11
• TASC Card Application (for your dependent)

Financial Planning:

• Application for Financial Planning Reimbursement

Life Insurance:

• Designate your beneficiaries for life insurance plans through benefitsCONNECT
  

Medical Plan Forms:

• BlueCross BlueShield of Minnesota Subscriber Claim Form
• Options Blue/Accord HRA Worksheet 
• HRA SelectAccount Crossover Option
• Pay the Provider Option
• SelectAccount Health Reimbursement Arrangement Claim Form

Retirement Plan Forms:

• Retirement Salary Reduction Agreement
• TIAA-CREF Lifetime Maximum Deferral Calculation Authorization

Employee Appraisal

• Tips for Supervisors
• Annual Performance Appraisal/Goal Setting Form

Job Descriptions

• Exempt Job Description
• Non-Exempt Job Description

Leaves

• CLSP (Catastophic Leave Sharing Program) Description for Non-Exempt, Non-Union Staff
• CLSP (Catastrophic Leave Sharing Program) Application
• CLSP (Catastrophic Leave Sharing Program) Donation
• CLSP (Catastrophic Leave Sharing Program) Physician's Statement
• Exempt Professional Development Leave
• Personal Leave of Absence Form

Miscellaneous 

• Direct Deposit 
• MN College Savings Plan Change 
• Personal Information Change
• Minnesota W-4
• Federal W-4 
• Form I-9 (Employment Eligibility Verification) 
• Volunteer Work Form
• Fair Labor Standards Act Fact Sheet

Recruitment

• Hiring Approval Form
• Independent Contractor Information Sheet
• Independent Contractor Checklist
• Job Posting Process
• Position/Salary Change Request Form
• Staff Recruitment Expense Guidelines/Process
  

Workers' Compensation

• Employee Accident Report
  
• Workers' Compensation Information Sheet
• State of MN Information Sheet
• Report of Work Ability
• Mandatory State and Federal Workplace Posters

Performance Improvement Plan

The following forms were reviewed within the EAP "Performance Management and Progressive Discipline" training sessions: 

• Performance Improvement Plan
• Performance Improvement Plan:  Feedback & Action Plan
• Performance Improvement Plan:  Follow Up