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Employee Forms


To open a form, please click on the form name.  In order to view and print the forms, you must have Adobe Acrobat or Acrobat Reader installed on your PC.  Click here to download the Acrobat Reader for free.

form_move

 Moving? Change of Address Form
form_job  Outside Employment Form
form_call  HIPAA Caller Authorization Form
bene_brush  Dental Claim Form

 Dental Enrollment Form
 bene_doc1

Medical Claim Form

Medical Enrollment/Change Form

bene_glasses  Vision Enrollment Form
form_pers  Prescription Claim Form
form_dep  Affidavit of Dependent Eligibility
form_flex  Flexible Spending Account Forms
form_ed

Educational Reimbursement Form

Educational Reimbursement Form - EMS  Union Contract Employees Only

form_opt

Minnesota Life Forms

form_leave  FMLA Request for Family or Medical Leave

 Non-FMLA Leave Request
bene_std Short Term Disability Forms - Long

Short Term Disability Forms - Short
 

 

 

 

 

 

 

 

 


 

 

 





 

 

 

 

 

 

 

 

 

 

 

 

 

 



Lee County Human Resources
2115 Second Street, First Floor 
Fort Myers, FL 33901-0398
239-533-2245