Human Resources

Leave Forms

• FMLA Leave Request Packet
• Certification Forms - These forms are PDF documents in FORM FIELD versions that can be filled in on the computer before printing. Unless you have the full version of Adobe Acrobat (not just the Reader) you will not be able to save or email a completed form. You must print the form before you close it.
  • Certification of Health Care Provider for Employee’s Serious Health Condition
  • Certification of Health Care Provider for Family Member’s Serious Health Condition
  • Certification of Qualifying Exigency For Military Family Leave
  • Certification for Serious Injury or Illness of Covered Service member -- for Military Family Leave
• Intermittent FMLA Tracking Form - Certified and Central Staff
• Intermittent FMLA Tracking Form - Classified
• Leave of Absence Request Packet If leave is for medical reasons a Certification of Healthcare Provider form must also be completed.
• Return to Work Certification Form
• Important Information about Adding your Newborn to your Group Insurance Plans
• Insurance Rate Sheet
• Change in Family Status Form
• Declining Insurance Coverage Acknowledgement Form
• Health Care Dependent Validation Form
• Regence Medical Form
• Delta Dental / Vision Service / Life Beneficiary Form
• Flexible Benefits Plan Enrollment Form & Packet - COMING SOON!
• PERSI Base Plan and Choise Plan Beneficiary Designation Form - COMING SOON!
• Insurance Enrollment Form (To obtain this form send your request to: )
• Flexible Benefits Plan Enrollment Form and Packet (To obtain this form send your request to: )
• PERSI Base Plan and Choice Plan Beneficiary Designation (To obtain this form send your request to: )
• Form W-4
• Sick Leave Bank Requests
  • Certified/Central Staff Sick Bank Request Packet
  • Classified/F&O/Food & Nutrition Services Sick Leave Request Packet

For more information email or call Employment and Benefits 854-4074. If you have Payroll questions, please contact the Payroll Department at

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