Human Resources

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Benefit Forms



Waiver Form

Waiver Form - (If moving TO or FROM a Waiver status)


Medical Enrollment and Change Forms

Blue Shield HMO Enrollment Form

Blue Shield HMO Change Form

Blue Cross PPO Enrollment Form

Blue Cross PPO Change Form

Companion Care Enrollment Form


Dental Enrollment and Change Forms

Delta Dental Enrollment Form

Delta Dental Change Form

GoldenWest Enrollment Form

GoldenWest Change Form


Switching between Blue Cross PPO plans or between Delta Dental plans Forms

Switch Form


Life Insurance Enrollment and Change Forms

Basic Life Enrollment Form

Basic Life Beneficiary Change Form


Pre-tax/Post-tax Out-Of-Pocket Premium Form

Tax Form



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