Forms (Employee)
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PAYROLL AND BENEFITS FORMS
VA-4 Employee Withholding Form
Anthem Health Insurance Application
Anthem Dental Insurance Application
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
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
Educational Supplement Request
Employee Demographics Change Form (Name/Address)
Long Term Substitute Teacher Payroll Form 2016-2017 (PDF)
Long Term Substitute Nurse Payroll Form 2016-2017 (PDF)
Reimbursement Travel Mileage Form (Excel) Effective January 1, 2016
Reimbursement Travel Mileage Form (pdf) Effective January 1, 2016
Payroll Deduction Approved Vendor List
Sick Leave Bank Membership Form (Rev. 7/2015)
Tuition Reimbursement Request for Service Employees
