Human Resources

Frequently Used Forms

Please return all forms to the Vancouver Human Resources office, Administration Bldg. 126

Medical & Dental

Enrollment & Change Form: Use this form to enroll within 31 days of initial eligibility. This form is also used update name, and address changes, and to enroll newly acquired dependents (e.g. new spouse, newborn, adoption) within 60 days of becoming eligible.
Spouse or Qualified Domestic Partner Certification: This form must be completed If enrolling a spouse or qualified domestic partner.
Student Certification Form: Use this form if enrolling dependent children ages 20 through 23.
Certification of Dependents with Disabilities
Extended Dependent Certification

Life Insurance

Enrollment Form: Use this form if you enroll within 60 days of initial eligibility.
Change Form: Use this form if you enroll more than 60 days after initial eligibility, or if you want to change your current life insurance.
Evidence of Insurability Form
Beneficiary Change Form
Non Smoker Certification Form
Conversion Form

Long Term Disability

Public Employees' Retirement System (PERS)

Participation Election Form
How To Enroll Online Guide
10% Increased Contribution Form: At any time following your 50th birthday you may elect to increase your contribution rate to 10%.
Enrollment Form: Use this form to enroll by mail. Use the How to Enroll Online Guide above to enroll online.
Salary Reduction Agreement Form: Use this form to designate your desired contribution for the supplemental Tax-Deferred Investment Plan.

Flexible Spending Account & Dependent Care Assistance Program

Enrollment Form: Use this form to enroll within 31 days of initial eligibility.
FSA Claim Form
FSA & DCAP Claim Form
FSA & DCAP Change Form: Allows you to make changes to an account for qualifying events.

Additional Forms

Commonly Used Payroll Forms

Some of the forms listed on this page may require Adobe Reader