Employee Forms

Forms

  1. W 4 2016 Federal Withholding (PDF)

Open Enrollment Forms

  1. 07212 Summary of Benefits Base (PDF)
  2. 07212 Summary of Benefits Buy Up (PDF)
  3. 2021 Benefit Guide 10.15.2020 (PDF)
  4. 2021 City OE Worksheet 10-21-20 Fillable (PDF)
  5. AICK_4 Enrollment (PDF)
  6. BCBS Change Form (PDF)
  7. BCBS Dental BASE Summary (PDF)
  8. BCBS Dental BUYUP Summary (PDF)
  9. BCBS Enrollment Form (PDF)
  10. SBC Uniform Glossary (PDF)
  11. Superior Enrollment (PDF)

Employment Management Forms

  1. 2014 Salary Scales 6-22-14 (XLSX)
  2. Comp Plan Updated Adopted 06-19-2013 (PDF)
  3. Discipline Form 2-7-13 (PDF)
  4. Employee Cell Phone Allowance Agreement (PDF)
  5. Incident Investigation Report 2013 (PDF)
  6. PAR Writeable Form (PDF)
  7. Performance Appraisal Form 2-5-13 (PDF)
  8. Time Sheet Blank 2014 (XLSX)
  9. W 4 2016 (PDF)

Employee Self Service Forms

  1. Emergency Contact Change Form (DOCX)
  2. Emergency Contact Change Form (PDF)
  3. Emporia Fitness Payroll Deduct Enrollment (PDF)
  4. Health Club Reimbursement Form (PDF)
  5. K-4 State Withholding if You Want Different From Federal (PDF)
  6. KPERS Designation of Beneficiary Form (PDF)
  7. Payroll Direct Deposit (PDF)
  8. UHC Enrollment Change Form (PDF)
  9. W4 2017 (PDF)

Employee Health Life KPERS Forms

  1. Health Club Reimbursement Form rev 5 2015 (PDF)
  2. Qualifying Events and What Changes Can Be Made to Your Health Insurance (PDF)
  3. Secure Benefit Claim for Reimbursement (Flex Spending) (PDF)
  4. Secure Benefit Direct Deposit Form (Flex Spending) (PDF)
  5. UHC Enrollment Change Form (PDF)