STAFF FORMS & RESOURCES

Employee Forms​

SUBCENTRAL

• Background Check Form 
• Change of Address 
• College Recommendation 
• Copy Center Form 
• Copy Center Services and Guidelines
• Credit Card Use Agreement
• Credit Card - Missing Receipt form
• DOT Physical Reimbursement Form for Bus Drivers 
• Field Trip Request Form 
• Out of State Trip Request (doc)
• Out Of State Trip Request (pdf)
• PPEL Use of Funds Request Form
• PPEL Use of Funds Request Form PDF
• Student Accident Report 
• Suggestion Form - Faculty/Staff 
• Teacher Master Contract
• Timecard - paper version
• Time Clock View Hours
• Teacher Quality/Professional Development Form (TQ/PD)
• Travel Reimbursement Form 
• Trip Form - Washington Elementary  (doc)
• Trip Form - Washington Elementary (pdf)
• United Way 211 Help 
• Work Related Injury - Treatment Notice 
• Work Related Injury Report

Employee Benefit & Payroll Forms

• Payroll Income Tax Withholding           Form W-4
• W-4 IA Form - Iowa Income Tax Withholding
• Direct Deposit of Payroll 
• IPERS Enrollment - Beneficiary 
• Form I-9 - New Employees   


• Annuities
• Annuity Retirement Savings Enrollment Form 
• Annuity Retirement Savings Information Website 
• Why save for retirement
• Annuities - How to set up an account


• Flexible Spending
• Flexible Spending Plan - Enrollment Form 
• Flexible Spending Plan example
• Flexible Spending Eligible Expenses Examples
• Flexible Spending Plan - Website
• Flexible Spending Plan- Claim Form 
• Flexible Spending Plan- Direct Deposit Setup 
• Flexible Spending Plans - Change of Status 
• Flexible Spending Plans-Certification for Certain Expenses
• Flexible Spending Plan Summary


• Health Insurance 
• Health Insurance Plans Summary Pages 1 and 2 2018 2019
• Health Insurance Plans Summary Pages 3 and 4 2018 2019 
• Contact Wellmark with insurance questions   
• Health Insurance 200 Summary Benefits/Coverage
• Health Insurance 2000 Summary Benefits/Coverage
• Health Insurance 750 Summary Benefits/Coverage
• Health Insurance 5000 Summary Benefits/Coverage
• Health Insurance Plan 200 
• Health Insurance Plan 2000 
• Health Insurance Plan 750 
• Health Insurance Plan 5000
• Health Insurance Open Enrollment Period
• Health Insurance Marketplace Notice 
• Doctor on Demand for school health insurance
• Discounts for having Wellmark health insurance
• Wellmark Identity Protection
• Wellmark Identity Protection signup
• Health Insurance changes when life events occur
• ​Other
• FMLA website information 
• Creditable Coverage Required Notice 
• LTD - TeacherAdministrator Long-Term Disability plan 
• LTD- Other Employees Long-Term Disability plan 
• Noncreditable Coverage 5000 Health Insurance Plan
• HIPAA Special Enrollment Notice
• Women's Health and Cancer Rights Act 
• Premium Assistance and Child Health Insurance Program
• Michelle's Law
• TQ/PD Form
• Time Clock - View Hours
• Web Link

New Employee Forms
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• New Employees Payroll and Benefits Forms Checklist

• Payroll and Benefits Information
• Teachers - Salaries and Benefits

• W-4 Form - Federal income tax withholding
• W-4 IA Form - Iowa income tax withholding
• I-9 Form
• School Foundation Employee Donation Form
• ​Substance Free Workplace Notice to Employees-Agreement Form 
• Emergency Contact Information 
• Direct Deposit of Payroll
• Credit Card Use Agreement
• Flexible Spending Plan Enrollment Form
• Flexible Spending Plan example
• Flexible Spending Plan - Direct Deposit
• IPERS
• Annuity Retirement Savings Plan - Enrollment Form
• Health Insurance Plans Summary pages 1 and 2 
• Health Insurance Plans Summary pages 3 and 4
• Contacting Wellmark with health insurance questions
• HSA - Health Savings Accounts
• Mercer Administration - Health Insurance Enrollment Form​

• Information
• ​Teacher Master Contract 2017-2019
• Student Loan Reduction Program
• Clarification on Credits
• Copyright Guidelines
• Work Related Injury - Treatment Notice
• Safety Reminder from our Insurance Company
• Benefits of Pre-Tax plans


• Legal Notices
• Provider - Choice Rights
• Michelle's Law
• Newborns' and Mothers' Health Protection
• COBRA Notice
• Premium Assistance and Child Health Insurance Program 
• Medicare Part D Notice
• HIPAA Special Enrollment Notice
• Women's Health and Cancer Rights Act 
• HIPAA Privacy Notice
• Marketplace Federal Exchange Notice​
• FMLA Notice