Forms (Employee)
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Open Enrollment - July 22 through August 30, 2019
October 1, 2019 effective date
Open Enrollment Details and Instructions
PAYROLL AND BENEFITS FORMS
You may now manage changes to your tax forms, direct deposit account and personal information through the Employee Self Service (ESS)online portal at ess.staffordschools.net. Rather than printing, completing, signing and submitting paper forms, simply log in to your ESS account and complete the process in a few easy steps.
VA-4 Employee Withholding Form
Anthem Health Insurance Application
Anthem Dental Insurance Application
Direct Deposit Authorization *
Apple Federal Credit Union Allocation Form
Employee Demographics Change Form
Employee Data Change Form (changes to payroll deductions)
Unreimbursed Medical Reimbursement Form
Mark III / Flexible Benefits Administration Forms
Qualifying Event Form Flexible Benefits Plan
WHAT FORMS DO I NEED FOR A NAME CHANGE
Log in to your ESS account to complete your name change information quickly and conveniently. Select the Personal Information, the Add/View changes. Please keep in mind that you will need to upload a copy of your Social Security Card, with your new name before the changes will be approved.
Below are links to the forms required for a name change. Please complete and return them to the Payroll and Benefits Department as soon as possible. Changes received by the 15th of the month will take place on the first of the month. Changes received after the 15th of the month will take place the month after next. A copy of your Social Security Card, with your new name is required before any changes will be made.
Employee Demographics Change Form - (Update Name or Address) This form does not make any changes to payroll deductions.
VRS-2 Designation of Beneficiary - May or may not be necessary unless you want to change your present beneficiary. Please be sure to complete both sides, sign and date the form.
Federal and State Tax Forms - May or may not be necessary unless you want to change your tax status from what you are currently claiming.- Form W-4 Employee's Withholding Allowance Certificate
- Form VA-4 Employee's Virginia Income Tax Withholding Exemption Certificate
OTHER FORMSProfessional Leave Short Form(MS Word)
Professional Leave Short Form (PDf)
Conference Professional Reimbursement
Employee Demographics Change Form (Name/Address)
Reimbursement Travel Mileage Form (Excel) Effective January 1, 2018
Payroll Deduction Approved Vendor List
Sick Leave Bank Membership Form (Rev. 7/2015)
