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Human Resources

 
Employee Human Resource Documents
 
Employee Notification of Change Forms:
Change of Address (PDF)
Paycheck Release Authorization (PDF)
2013 Federal Withholding W-4 (PDF)
2013 Employee's Withholding Allowance Certificate(PDF)
Authorization for Direct Payroll Deposit (XLS)
IRS Announcement of Pension Plan Limitations for 2013 (PDF)
 
CalPERS Related:
Medical Report for the CalPERS Disabled Dependent Benefit  (PDF)
Member Questionnaire for the CalPERS Disabled Dependent Benefit  (PDF)
CalPERS 2010 Your Health Care, Your Choices  (PDF)
CalPERS 2010 Health Benefits Summary (PDF)
The Prescription for Quality Health Care (PDF)
2010 Health Program Guide (PDF)
CalPERS 3% @60 GRID PLUS LOCAL MISC BENEFITS (PDF)
PLANNING YOUR SERVICE RETIREMENT (PDF)
CalPERS PURCHASING SERVICE CREDIT OPTIONS (PDF)
HEALTH BENEFITS MEDICAL CHANGE FORM (PDF)
DECLARATION OF HEALTH COVERAGE (PDF)
COBRA ELECTION (PDF)
COBRA FORM (PDF)
CalPERS - Retirement Allowance Estimate Request  (PDF)
CalPERS - Service Retirement Election Application (PDF)
CalPERS - A Guide to Complete Your Disability Retirement Election Application (PDF)
CalPERS - Special Power of Attorney (PDF)
CalPERS - Quality Report(2006-2007) (PDF)
CalPERS - Health Benefit Summary (PDF)
CalPERS - Health Program Guide (PDF)
CalPERS - Beneficiary Designation Form
CalPERS - A Guide to Employment after Retirement
Blue Cross Member Claim Form (PDF)
CalPERS Affidavit of Parent-Child Relationship (PDF)
 
 
Premier Access Dental:
Premier Access Dental Plan (PDF)  
Premier Access Dental - Welcome Letter (PDF)  
Premier Access Dental - Employee Enrollment/Change Form( PDF)
Premier Access Employee App Change Form (Spanish/Español)( PDF)
Premier Access Federal and State COBRA Election Enrollment Form (PDF)
Premier Access Dental Claim Form (PDF)
Premier Access Individual Waiver Statement (PDF)
Premier Access Grievance Form (PDF)
Dental Directory (PDF)
 
 
Medical Eye Services Vision:
Patient Claim Form (Medical Eye Services) (PDF)
Non-Elective (Medically Necessary) Contact Lenses Approval Request Form (PDF)
AIG(American International Companies ) Vision Plan Enrollment/Change Request Form (PDF)
AIG(American International Companies ) Application for Group Vision Coverage (PDF)
AIG(American International Companies ) Vision Coverage Summary (PDF)
 
Sun Life Financial:
Group Life Conversion Employee Kit - Life Insurance Options (PDF)
Group Life Conversion Notice (DOC)
Group Life Portability Employee Kit (PDF)
Application for Portable Group Life Insurance (PDF)
Beneficiary Designation (DOC)
Evidence of Insurability Cover Page (DOC)
Short-Term Disability Claim Packet (DOC)
Group Short-Term Disability - How to Submit a Claim (PDF)
Long-Term Disability Claim Packet - Claimant (DOC)
Long-Term Disability Claim Packet - Employer (DOC)
Long-Term Disability Claim Packet - Attending Physician (DOC)
Optional Life Insurance Benefits (DOC)
Optional Life Enrollment Application (DOC)
Life Claim Form (DOC)
 
CALPERS 457 Deferred Compensation
457 Account Transfer Form (PDF)
457 Application for Electronic Direct Deposite (PDF)
457 Beneficiary Designation Form (PDF)
457 Three-Year Special Catch-up Worksheet (For current Employee Only) (PDF)
457 Participant Change Authorization Form (PDF)
457 Participant Change Authorization Form(with Employer Contributions) (PDF)
457 Death Distribution Request Form (PDF)
Direct Rollover Request Form (PDF)
Distribution Request Form (PDF)
Emergency Withdrawal Request Form (PDF)
Employee New Enrollment Form (PDF)
Employee New Enrollment Form (with Employer Contributions) (PDF)
In-Service Withdrawal/Transfer Request Form (PDF)
Inter-Plan Transfer Form (PDF)
Rollover Form (PDF)
Rollover Request Form for CalPERS Service Credit Purchase (PDF)
Contribution Remittance Form (PDF)
Notification of Separation from Employment Form(Employer Use Only) (PDF)
CalPERS 457 Deferred Compensation Plan Amount of Deferral Change Form (PDF)
CalPERS 457 Supplemental Option Plan (PDF)
CalPERS 457 Making Cents (PDF)
CalPERS 457 Supplemental Income 457 Plan Enrollment Kit (PDF)
 
ICMA 457 Deferred Compensation:
How Your 457 Plan Works(PDF)
ICMA 457 Employee Enrollment Form (PDF)
ICMA 457 Employee Information Change Form (PDF)
ICMA 457 Amount of Deferral Change Form (PDF)
ICMA Trustee to Trustee Packet (PDF)
ICMA 457 Loan/Refinance Form Packet
457 Deferred Compensation Plan Benefit Withdrawal Packet
Purchase of Prior Service Credit Packet (ICMA Retirement Corp.) (PDF)
Direct Rollover/Transfer to ICMA-RC Packet (PDF)
457 Plan Co-Provider Transfer to ICMA-RC Form (PDF)
 
ING 457 Deferred Compensation:
ING Allocation Change/Fund Transfer (PDF)
ING Custom Choice Enrolloment Form(457 Deferred Comp. Plan) (PDF)
ING 457 Loan Agreement (PDF)
ING Unforeseeable Emergency Withdrawal (PDF)
Service Buy Back Withdrawl and Transfer to Government Defined Benefit Plan (PDF)
Miscellaneous Withdrawl Request(Education, Healthcare and Governmental Markets) (PDF)
 
PARS (Public Agency Retirement Services):
PARS - General Information (PDF)
PARS - Request for Distribution(PDF)
PARS - Designation of Beneficiary Form (PDF)
Request For Distribution Form (PDF)
 
Others:
Year 2010 Employee Holiday Schedule (PDF)
EDD EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE (PDF)
IRS Announcement on Pension Plan Limitations for 2010
 
Memos:
FMLA Packet  (PDF)
Notice A -  Pregnancy Disability Leave  (PDF)
Notice B -  Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability Leave (PDF)
Your Rights under the Family and Medical Leave Act of 1993 (PDF)
Notice of Military Family Leave (PDF)
   
 
 

 
City Hall Address: 701 E Carson Street, Carson, California 90745
City Hall Hours: (310) 830-7600, 7 AM - 6 PM, Monday - Thursday
24-hour automated: (310) 952-1700
Contact a specific employee: Employee Directory

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