Human Resources Forms & Information

COVID-19 City of Burlington Employee Forms and Information

• Emergency Leave Policy
• Emergency Leave Request Form
• Families First Coronavirus Response Act (FFCRA) Expanded Family & Medical Leave FAQ
• FFCRA Employee Rights Poster
• Protocols for COB COVID-19 Positive Cases
• Cloth Face Covering Policy

Application Materials

• Application for Employment (Word Document)
• Application for Employment (PDF)
• 2019-2020 BFD Hiring Process V1

Basic Employment Forms

• I-9 Form
• 2020 W-4
• 2020 Direct Deposit Authorization Form
• INSTRUCTIONS -  How to Complete Direct Deposit Authorization Form
• Declaration of Health Care
• Employee Change of Status form
• Employee Personal Information Questionnare

Comprehensive Personnel Policy Manual

• Comprehensive Personnel Policy Manual

Contracts

• AFSCME Contract 2018-2022
• Fire Contract 2018-2022
• IBEW Contract 2018-2022
• Police Contract 2018-2022

Dental Insurance Forms

• Delta Dental Coverage Information
• Delta Dental Enrollment Form
• Delta Dental Student Verification

Domestic Partner Enrollment Forms

• Domestic Partner Affidavit

ICMA Forms

• Employee Information Change Form ICMA
• 457 Amount of Deferral Change form ICMA

Flex & DCAP Forms

• FLEX Direct Deposit Form
• FLEX Reimbursement Form
• DCAP Reimbursment Form
• 2020 FLEX Enrollment Form

FMLA and Leave Forms

• FMLA Request Form

Health Insurance / Prescription

• Cigna Medical Health Insurance Form
• Cigna Medical Health Health Plan Summary
• GISC Health Insurance Enrollment Form
• GISC Employee Benefit Health Plan Summary
• COBRA Continuation Notice
• Notice of Privacy Practices
• Affordable Care Act Marketplace Notice
• Health Insurance Buyout Form
• CanaRx BurlingtonMeds

Miscellaneous HR Materials

• Holiday List 2019
• Holiday List 2020
• Livable Wage July 2019
• Reasonable Suspicion Checklist
• Reasonable Suspicion Training Frequently Asked Questions
• Sustainability Presentation
• Wellness Bonus Health Risk Assessment Survey
• Wellness Bonus Proof of Annual Dental Examination
• Wellness Bonus Proof of Annual Physical Examination

Nationwide Form

• Nationwide Enrollment/ Change Form