City of Burlington, Vermont

City of Burlington, Vermont

200 Church Street, Suite 102 
Burlington, VT 05401
Phone: 802-865-7145 Fax: 802-864-1777


Human Resources Forms

Application Materials

Application for Employment (Word Document)

Application for Employment (PDF)

Firefighter Application Schedule 2017-2018


Basic Employment Forms

2017 I-9 Form

2018 W-4

Declaration of Health Care

Employee Change of Status form

Employee Personal Information Questionnare


Comprehensive Personnel Policy Manual

Comprehensive Personnel Policy Manual


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

2018 FLEX Enrollment Form


FMLA and Leave Forms

FMLA Request Form


Health Insurance 

GISC Health Insurance Enrollment Form

GISC Employee Benefit Health Plan

COBRA Continuation Notice

Notice of Privacy Practices

Affordable Care Act Marketplace Notice


Health Insurance Buyout Forms

Health Insurance Buyout Form


Miscellaneous HR Materials

AFSCME Contract 2014-2018

ADA Grievance Procedure

Police Contract 2014-2018

Fire Contract 2014-2018

IBEW Contract 2014-2018

Holiday List 2018

Livable Wage July 2017

Reasonable Suspicion Checklist

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