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Employee Benefits Forms

Temporary ID Cards

Benefits Enrollment Forms

Health Plan Forms

Life Insurance Beneficiary Form

403(b) Forms

Leave of Absence and Short-Term Disability Forms

  • Leave of Absence-The Hartford: For employees who need time away from work due to a medical condition, including pregnancy, surgery, in-patient admission or absences of more than seven calendar days. Eligibility is the first of the month following one year in a benefits eligible status of 32 hours or more per pay period.
  • Leave of Absence-Medical (Not Eligible For Short-Term Disability): For employees who still need time away from work due to your own medical condition, including pregnancy, surgery, in-patient admission or absences of more than seven calendar days. If you have not been employed for at least one year, please use this form for applying for a leave of absence.
  • Leave of Absence- Medical (self -intermittent): When time away from work is due to an employee's own chronic medical condition which causes episodic absences.
  • Leave of Absence-Family (intermittent or continuous): When time away from work is needed to provide care to the employee's spouse, parent or child. May also be used due to placement of a son or a daughter for adoption or foster care.
  • Leave of Absence-Personal & Educational: When time away from work is for personal or educational reasons.
  • Leave of Absence- Military: When time away from work is due to Reserve or National Guard duty, employee who is a covered service member who is on active duty or call to active duty.

Workers' Compensation Forms

General Administration Forms