Benefits

CIGNA Medical Claim Form (39k)
CIGNA Vision Claim Form (38k) 
Declaration Health Coverage Form (61k)
Deferred Compensation Enrollment Form (120k)
Direct Deposit Request Form (Link to State Employee Payroll)
Dental Claim Form (747k) 
Domestic Partner Application & Policy (195k) 
FSA Direct Deposit Form (77k)
FSA Enrollment Form (39k)
FSA Reimbursement Claim Form (261k) 
Health Benefits Pre-tax Form (38k)
Life Insurance Beneficiary Designation Form (36k)
Life Insurance Enrollment Form (38k)
Life Insurance Evidence of Insurability Form (43k)
LTD Claim Form Packet (692k) 
Medical & Dental Enrollment Form (278k)
Prescription Drug Claim Form (37k)
Prescription Mail Order Form (32k) 
Qualified Dependent Declaration Form (82k)
VHEIP Deduction Authorization Form (55k) 
 

Child/Elder Care

Child Care Reimbursement Form (184k)
Elder Care Reimbursement Form (174k)
 

Classification & Position Management 

JFO Limited Service Position Request Form (20k)
Job Share Agreement Form (51k)
Position Pool Request Form (39k)
Request for Review-Employee Form (103k)
Request for Review-Job Series Form (57k)
Request for Review-Management Form (103k)  
Request for Review-Vacant Position Form (66k)  
Temporary Request Form (80K)
 

Compensation 

Exempt Salary Request Form (51k)  
Request for Hire-Into-Range Form (52k)
Request for Market Factor Review (49k)
 

Employment

Alternative Work Schedule Form (197k)
Equal Employment Opportunity Employee Data Form (115k)
Form I-9, Employment Eligibility Verification (Link to Department of Homeland Security)
Statement of Employment Conditions for Temporary Employees (40K)
State of Vermont Temporary Employment Application (182k)
 

Family & Medical Leave 

Certification Health Care Provider - Employee (12k)
Certification Health Care Provider - Family Members (12k)
Employee Request for Parental or Family Leave (15k)
Employer Response to Request for Parental or Medical Leave (14k)
 

HCM 

HRMS Access Request Form (35k)

Individuals with Disabilities

Reasonable Accommodation Request Form (18k)
Request for Mandatory Interview Form (99k)
 

Internships 

Internship Application Form (123k)
Internship Proposal Form (122k)
Evaluation Form for Interns (304k)
Evaluation Form for Intern Supervisors (371k)
  

Pay & Expense Reimbursement 

Deferred Compensation Plan Form (Link to State Employee Payroll)
Delegation of Authority Form (Link to State Employee Payroll)
Direct Deposit Request Form (Link to State Employee Payroll)
Federal W-4 Form (Link to State Employee Payroll)
Federal W5 (Earned Income Credit Form) (Link to State Employee Payroll)
Reimbursement of Travel Expense Form for all State Employees (Link to State Employee Payroll)
Reimbursement of Travel Expense Form for VTRANS Employees (Link to State Employee Payroll)
Request for Salary Advance Form (Link to State Employee Payroll)
Savings Bond Form (Link to State Employee Payroll)
Special Check Request Form (Link to State Employee Payroll)
Vermont W-4 Form (Link to State Employee Payroll)
Waiver of DD Request Form (Link to State Employee Payroll)
W-5 Earned Income Credit Form (Link to State Employee Payroll)
 

Performance Management 

Performance Evaluation Report Form (54k)
 

Prior Service Credit

Application for Prior Classified Service Credit Form (54k)
Application for Prior Exempt Service Credit Form (53k)
Application for Prior Temporary Service Credit Form (49k) 
 

Sick Leave Bank

Sick Leave Donation Form (150k)
Sick Leave Bank Application Form - Corrections (84k)
Sick Leave Bank Application Form - Management/Confidential (84k)
Sick Leave Bank Application Form - Non-Management (91k)
Sick Leave Bank Application Form - Supervisory (84k)
 

Training & Development 

Summit Registration Form (108k)
Tuition Reimbursement Application Form (299k)
Tuition Reimbursement Career Plan (24k)
Workforce Development Consulting Request Form (94k) 
 

Workers Compensation/Workplace Safety

Employee's Claim and Employer First Report of Injury (Link to Office of Workers Compensation)
Safety & Health Committee Complaint Form (25k)