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Forms
Below are forms that may be usefull in completing benefits and Human Resources related tasks.
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/gov/dept/HumanResources/Lists/edoColumns_g_c82f1242_a4c0_4d8d_b7b6_3714b26c47c5/AllItems.aspx
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http://www.leegov.com/gov/dept/HumanResources
Medical/Dental/Vision
Enrollment/Change Form
Medical Claim Form
Dental Claim Form
Affidavit of Dependent Eligibility (26-30)
Affidavit of Grandchild Eligibility
Affidavit of Permanent Disability
Aetna Home Delivery
Prescription Drug Claim
Pretax Premium Drop Form
Retiree Benefits Change Form
Human Resources Forms
Change of Name and Address
Direct Deposit Enrollment
Direct Deposit Cancel
Outside Employment
2012 W4
FMLA Leave Request
Non-FMLA Leave Request Form
Non-FMLA Leave Request (with Furlough)
Education Reimbursement
(EMS Union Contract Employees Only) Education Reimbursement
Flexible Spending
FSA Enrollment
FSA Healthcare Reimbursement
FSA Dependent Care Reimbursement
FSA OTC Drug Reimbursement
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/gov/dept/HumanResources/Lists/edoColumns_g_0834bd00_4f2a_4bb4_ad0e_de43684c3741/AllItems.aspx
/gov/dept/HumanResources/Lists/edoColumns_Properties_g_0834bd00_4f2a_4bb4_ad0e_de/AllItems.aspx
http://www.leegov.com/gov/dept/HumanResources
Life and Disability Insurance
Long and Short Term Disability
Minnesota Life Enrollment Form
Evidence of Insurability Form
Beneficiary Change Form
Deferred Compensation 457
ICMA 457 Enrollment Form
ICMA (Spanish) 457 Employee Enrollment Form
ICMA 457 Direct Deposit Form
ICMA 457 Change Form
ICMA 457 Catchup
ICMA 457 Account Transfer Packet
ICMA Tax Notice
ICMA 30 Day Waiting Period Notice
VSP (Vision Services Plan)
VSP Member Out of Network Claim Form
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