HR Forms

Click to View and/or Print the Appropriate Form(s):



2018 - 2019  FLEXIBLE SPENDING ACCOUNT:  (new)

2018 - 2019 Flexible Spending Account (FSA) Enrollment Form

Flexible Spending Account (FSA) Information Packet



DIRECT DEPOSIT:

Direct Deposit (Contact Human Resources Department)


DISCIPLINARY PROCESS:

Disciplinary Action Report


EMPLOYEE DATA FORM: (new)

Employee Data Form


EMPLOYEE EMERGENCY CONTACT FORM:

Employee Emergency Contact Form 



E-STUBS (Electronic Paystub System):

E-Stubs Request Form 


EAP/REACH:

EAP Reach Pamphlet 

EAP Supervisor Referral Form


EXIT PROCESS: 

Separation Process Form 


FAMILY MEDICAL LEAVE ACT (FMLA):

FMLA Employee Rights and Responsibilities

FMLA Fact Sheet 28

FMLA Certification of Health Care Provider for Employee's Serious Health Condition

FMLA Certification of Health Care Provider for Family Member's Serious Health Condition

FMLA Fact Sheet 28A Military

FMLA Certification for Serious Injury or Illness Covered Servicemember for Military Family Leave

FMLA Certification of Qualifying Exigency for Military Family Leave


GRIEVANCE PROCESS:

Grievance Form


LEAVE SHARE PROGRAM:

Leave Share Recipient Application Form

Leave Share Donor Form


OUTSIDE EMPLOYMENT FORM:

Secondary (Outside) Employment Request


PERSONNEL ACTION FORM (PAF):

Personnel Action Form (PAF)  

(PAF) for Leave Payout


REQUEST TO HIRE FORM:  

Request to Hire / Recruitment Approval Form


SUBSTANCE ABUSE POLICY:

Supervisor Reasonable Suspicion Report Form

Reasonable Suspicion Consent Form



TAX FORMS:

VA-4 Form (State)

W-4 Form (Federal) - Email: HR@petersburg-va.org



Return completed form to the "Human Resources Department" unless form indicates alternate recipient.