Employee County Personnel Forms

All forms must be completed by employee and have all necessary accompanying documentation.

For any pension related questions, please contact the controller's office.

For ID badges, report to Operations in room 115.



BAI - Benefit Administration, Inc.

Employee Health Benefit and Contact Information

AFSCME Address/Name/Dependent Change Forms

•AFSCME Employee Update Forms
•AFSCME Student Certification Form
 * To continue student coverage, please attach copy of schedule or tuition bill.
•Erie County Municipality Sheet
•AFSCME - Keep Dependent Under 26 on Vision Plan

PSSU Address/Name/Dependent Change Forms

•PSSU Employee Update Forms
•PSSU Student Certification Form
* To continue student coverage, please attach copy of schedule or tuition bill.
•Erie County Municipality Sheet

Non-bargaining and ECAPE Address/Name/Dependent Change Forms

•Employee Update Forms
•Erie County Municipality Sheet

Medical

•PPO Benefit Grid/Provider List
•PPO Out of network Claim Forms
•Provider Directory

Flex Spending Enrollment and Information

•Flex Spending Enrollment and Information

2011 FSA Flex Spending Forms

•ACT 125 - Flex Spending Enrollment Form
•ACT 125 - Claim Form
•ACT 125 - Substantiation Form
•ACT 125 - Dependent Care Claim Form
•ACT 125 - Secondary Card Request Form

Vision

•Vision Description of Benefits
•Vision Benefit Request Form
•Vision Provider List
•Vision Benefits for Non-bargaining, Elected Officials, ECAPE, Detectives, Court Supervisors, Appointed Officials

Prescription

•Prescription Mail in Order Form
•Prescription Reimbursement Form

Dental

•BAI Description of Dental Benefits
•BAI Dental Claim Forms
•BAI Dental Provider List

Worker's Compensation

•Worker Comp. - Notice & Procedures
•Worker Comp. - Supervisor Report
•Worker Comp. - Incident Report
•Worker Comp. - Physician Panel
•Worker Comp. - Return to Work Slip

Exit Interview

•Exit Interview Policies and Procedures
•Employee Exit Interview Questionnaire
•Departmental Exit Interview Report

Miscellaneous

•I-9 Employment Eligibility Verification Form
•Compensatory Time Report
•Tuition Reimbursement Policy & Forms
•Emergency Contact Information
•Employee Request To Access Personnel File
•Mazzitti & Sullivan Employee Assistance Program
•Mercyhurst Employment Verification Form
•Life Insurance Change of Beneficiary Form

Employee Personnel Reference Documents

•Employee Handbook
•Personnel Policies and Procedures
•EMTA Shuttle
•Tuition Reimbursement Policy
•Maternity/Paternity/Adoption Leave Policy
•Anti-nepotism Policy


Policies Signed at Hire

•Policy 1 - Alcohol, Drugs, and Controlled Substances Prohibition
•Policy 3 - Computer Usage Policy
•Policy 6 - Drug-Free Workplace
•Policy 10 - Equal Employment Opportunity and Affirmative Action
•Policy 21 - Sexual Harassment
•Policy 36 - Worker's Compensation Policy (Work Related Injury/Illness)

Payroll Forms - Return to Suite 505

•W-4 Form
•Direct Deposit