Form |
Revised | Description |
11/08 |
Tax Shelter Payroll Deduction / Change Authorization |
|
6/11 |
Employee Medical History |
|
5/16 |
Knox County Check Request |
|
10/12 |
Classified Sick Leave Bank Request |
|
1/23 |
Travel Expense Reimbursement / Summary LOCAL TRAVEL ONLY |
|
1/23 |
Travel Expense Reimbursement / Summary OUT OF TOWN TRAVEL |
|
1/13 |
Certified Employees' Sick Bank Enrollment Request |
|
4/10 |
Cancellation Notification For Automatic Deposit |
|
1/13 |
Classified Sick Leave Bank Enrollment Request |
|
4/10 |
Authorization Agreement For Automatic Deposits (Credit) |
|
8/11 |
Certified Sick Leave Bank Physician's Statement |
|
8/11 |
Certified Sick Leave Bank Request to Use Sick Leave Days from Sick Leave Bank for Employee's Personal Illness |
|
5/11 |
Authorization and Request of Protected Health Information (PHI) – MENTAL HEALTH (for employees) |
|
5/11 |
Authorization and Request of Protected Health Information (PHI) – MEDICAL INFORMATION (for employees) |
|
1/16 |
Leave Request |
|
11/08 |
Payroll Deduction / Change Authorization |
|
4/11 |
Classified Sick Leave Bank Physician Statement |
|
10/12 |
Classified Sick Leave Bank Membership Cancellation |
|
|
Life Insurance Enrollment / Change Request |
|
|
Vision Insurance Enrollment / Change |
|
7/18 |
Health Enrollment Change Application (State of TN Group Insurance Program) |
|
|
Dental Insurance Enrollment / Change |
|
10/12 |
Insurance Intent |
|
BO-180B |
|
Leave of Absence – Continue Insurance Coverage |
BO-180C |
|
Leave of Absence – Suspend Insurance Coverage |
7/18 |
Insurance Cancel Request Application (State of TN Group Insurance Program) |
|
10/12 |
Certified Sick Leave Bank Membership Cancellation |
|
|
Physician's Verification of Illness and / or Maternity Leave |
|
7/23 |
Leave of Absence |
Employee Forms List
Collaborator
Written By Josh Flory
Updated at October 8th, 2024