Open Enrollment - July 22 through August 30, 2019

October 1, 2019 effective date

Open Enrollment Details and Instructions

Mark III Benefits Booklet

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.

W-4 Employee Withholding Form 

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

Approved Vendors List

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 FORMS

Direct Deposit Authorization

Professional 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)