Human Resources Forms

Employee Notification of Change Forms:
Change of Address/Employee Information Form (PDF)
Paycheck Release Authorization (PDF)
2019 Federal Withholding W-4 (PDF)
Authorization for Direct Payroll Deposit (PDF)

Effective Jan. 1, 2019
Mayor and City Council - (PDF)
($1,594.00 Monthly Allowance w/ Cap)
Full-Time and CPT Employees/City Clerk and City Treasurer - (PDF)
($1,594.00 Monthly Allowance w/ Cap)
Eligible Part-Time and Temporary Employees - (PDF)
($136.00 Monthly Allowance)
Eligible AFSCME Part-Time Employees w/8 years plus - (PDF)
($450.00 Monthly Allowance for Optional Benefits)

CalPERS - More Documents:
Medical Report for the CalPERS Disabled Dependent Benefit (PDF)
Member Questionnaire for the CalPERS Disabled Dependent Benefit (PDF)
The Prescription for Quality Health Care (PDF)
CalPERS COBRA Continuation Coverage (PDF)
CalPERS - A Guide to Complete Your Disability Retirement Election Application (PDF)
CalPERS - A Guide to Employment after Retirement
CalPERS - Affidavit of Parent-Child Relationship (PDF)
CalPERS - Election of Optional Membership - Elective Officer (PDF)

CalPERS - Health Benefit Summary - 2018 (PDF)

CalPERS - Health Enrollment / Change Form (PDF)
Health Benefits Plan Enrollment for Active Employees (HBD-12) Instructions (PDF)
CalPERS - Health Program Guide (PDF)
CalPERS - Justification for Absence of Spouse or Registered Domestic Partner's Signature (PDF)
CalPERS - Pre-Retirement Lump Sum Beneficiary Designation Form (PDF)
CalPERS - Retirement Allowance Estimate Request (PDF)
CalPERS - Service Credit Purchase Options (PDF)
CalPERS - Service Retirement Election Application Booklet (PDF)
CalPERS - Special Power of Attorney (PDF)
CalPERS - Request for Service Credit Cost Information - Service Prior to Membership (PDF)
Blue Cross Member Claim Form (PDF)
Principal Dental:
Principal Dental Benefits - Dental Expense Coverage (PDF)  
Principal Dental Form (PDF)  
Provider Operations Guide (PDF)  
Principal Dental Access Benifits (PDF)  
Employee Change Form (PDF)  
COBRA Continuation of Group Health Coverage Notification/Election Form (PDF)  
City of Carson Retirees Cigna Life Insurance
Cigna Life Insurance Amendment
Cigna Life Beneficiary Designation Form
LTD Certificate Class 01
LTD Certificate Class 02
LTD Certificate Class 03
STD Certificate Class 01
STD Certificate Class 02
Insurance Application (Class 1-3)
Insurance Application (Class 4-8)
Term Life Insurance Benefit Summary (Class 1-3)
Term Life Insurance Benefit Summary (Class 4-8)
How to Report a Life ADD Claim (PDF)
How to Report an STD LTD Claim (PDF)
City of Carson Full Time Employee EAP Brochure (PDF)
City of Carson Full Time Employee EAP Flyer (PDF)
Value Add Descriptions Cigna (Life ADD) (DOC)
Understanding your options to continue life insurance coverage - Portability and Conversion (PDF)
Portability of Voluntary Term Life Insurance (PDF)
Conversion of Group or Employee Life Insurance to an Individual Policy (PDF)
Group/Association - Short Term Disability Benefits (PDF)
Group Long Term Term Disability (PDF)
Group/Association - Proof of Loss Life Insurance Accidental Death Insurance (PDF)
Superior Vision
Superior Vision Insurance Enrollment/Change Form (PDF)
Superior Vision COBRA Enrollment/Change Form (PDF)
VOYA 457 Deferred Compensation:
Acceptance Letter for 457 Plans / Programs (PDF)
Adjustment Form (PDF)
Beneficiary Designation - Non-Erisa (PDF)
VOYA - 401(a) Group Variable Annuity - Retirement Plan Enrollment Form (PDF)
Employee Data Change Request (PDF)
Employee Termination / Retirement Witdrawal Request Education, Healthcare and Governmental Markets (PDF)
Enrollment Packet 457 (PDF)
Installment Loan Application and Promissory Note Government Retirement Plans (PDF)
Leave of Absence Request (PDF)
Miscellaneous Withdrawal Request Education, Healthcare and Governmental Markets (PDF)
Participation Agreement Governmental 457(b) Retirement Plan (PDF)
Top 10 Reasons to Participate (PDF)
Withdrawal and Transfer Request for Purchase of Governmental Defined Benefit Plan Service Credit - Instructions (PDF)
Fund Facts - Disclosure and Glossary (PDF)
VOYA Financial - Retirement Savings Plan Enrollment Guide (PDF)
PARS (Public Agency Retirement Services):
PARS - General Information (PDF)
PARS - Request for Distribution (Fillable PDF)
PARS - Designation of Beneficiary Form (PDF)
Take Care By Wage Works:
Take Care by WageWorks - Dependent Care (Howt o File a Claim for Approval) (PDF)
Take Care by WageWorks - HealthCare Account (Howt o File a Claim for Approval) (PDF)
Eligible Expenses for Your take care by WageWorks (PDF)
Health Care FSA Reimbursement Claim Form (PDF)
EDD Employee's Withholding Allowance Certificate (PDF)
IRS Announcement on Pension Plan Limitations for 2010
ID Shield (PDF)
LegalShield Legal Protection (PDF)
Colonial Life - Request for Service Form (PDF)
FMLA - California Family Care and Medical Leave Act - Forms
New Hire Clearance Packets
1. Adults Aquatics New Hire Clearance Packet (Fillable PDF)
2. Minors Aquatics New Hire Clearance Packet (Fillable PDF)
3. Part-Time Minors New Hire Clearance Packet (Fillable PDF)
4. Part-Time / Temp / Sports Officials (Non-Minors) New Hire Clearance Packet (Fillable PDF)
5. Adults Full-Time / Elected / Appointed New Hire Clearance Packet (PDF) New!
6. Full-Time Employee Benefit Orientation Forms Packet (Fillable PDF)

City Hall Contact

701 E Carson Street
Carson, CA 90745
(310) 830-7600, 7 AM - 6 PM
Monday - Thursday
24-hour automated: (310) 952-1700


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