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All forms listed below are in PDF format, and require the Acrobat Reader to be installed on your computer. Click here to download the Free reader. Also, some files are quite large and may take a few minutes to open if you are using a dial up internet connection.
- New Hire Packet
Individual Forms
- Employee Record Sheet
- Employment Application
- Alternate Dispute Resolution Agreement
- Direct Deposit Authorization
- W-4 Form
- I-9 Form
Medical
- Employers Resource Management Claim Form
- Framework Claim Form
Employers Resource Management Sponsored Medical Plan Enrollment Forms
- Kaiser
- PacifiCare
- Framework
Accident Claim Form
Dental
Prescription Drug Claim Forms
Employers Resource Benefit Trust/Envision RX
- Claim Form
- Mail Order Form
FSA/HRA
- Reimbursement Request Form
- Medical Necessity Form
Life Insurance
- Beneficiary Designation Form
- Supplemental Life Insurance Form
- FORM A: Additional Life Insurance Enrollment Form
- FORM B: Additional Life Insurance Medical History Statement
- Participating Client Application and List of Plan Options
- Short-Term (STD) and Long-Term Disability (LTD) Client Overview
- Employee Declination of Medical Treatment
- Participating Discount Program
- Safety Agreement
- Workers' Compensation Authorization Form
- Workers' Compensation Certificate of Insurance Request
- Workers' Compensation Claim Reporting Procedures
- Workers' Compensation Notice of Injury
- English
- Workers’ Compensation Claim Form (DWC 1 - California Only)
- Modified Duty Task Assessment
- ACH Debit Authorization
- Alternate Dispute Resolution Poster
- Payroll Deduction Authorization
- Disciplinary Action
- ERISA Poster
- Employee Record Sheet
- Notice of Employee Termination
- Miscellaneous Employee Payroll Deduction
- Request for Replacement Check
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