Forms

Dental - Dental Claim - Dental Enrollment/Change	Leave Requests - Request for Family or Medical Leave (FMLA) - Non-FMLA Leave Request
Education Reimbursement  - Education Reimbursement - (EMS Union Contract Employees Only) Education Reimbursement	Long & Short-Term Disability - STD short form - STD long form
Flexible Spending Accounts  - Direct Deposit - Streamline AutoDebit - Healthcare Spending Account Deduction Authorization - FSA Healthcare Reimbursement - FSA Over-the-Counter Healthcare Reimbursement - Dependent Care Enrollment - FSA Dependent Care Reimbursement	Medical  - Medical Claim - Medical Enrollment/Change - Affidavit of Dependent Eligibility - Prescription Drug Claim
HIPAA  - Caller Authorization	Minnesota Life  - Enrollment Form 2008 - Evidence of Insurability (EOI) Form - Beneficiary Designee
HR Forms - Change of Name/Address - Outside Employment - Direct Deposit Enrollment - Direct Deposit Cancel - 2008 W4 - Pretax Premium DROP Form	Vision  - Vision Enrollment/Drop

 

Lee County Human Resources

2115 Second Street, First Floor 

Fort Myers, FL 33901-0398

239-533-2245