Employee Forms
General Forms
Human Resources Forms:
- Employee Training Record Form: Provided to foster communication and understanding between supervisors and employees regarding specific tasks (click here)
- Change of Status Form (Individual): Required for any change to employee demographic or pay rate information. (click here)
- Change of Status Form (Multi): For use with multiple employee status or pay rate information changes (click here)
- Request for Leave of Absence (click here) Fillable form to begin the process of requesting a leave of absence.
- Employee Change of Personal Information Form: (click here) used to update changes to personal information. Name changes must include your updated social security card and a copy of your proof of legal name change (marriage cert/ divorce decree/court order). See VOYA name change form below if applicable.
Finance Office Forms:
CIRMA Work Related Injury Reporting Protocol
Department Heads and Supervisors: When sending an employee to CorpCare for a Workers Comp related injury, be sure to call CorpCare to let them know the employee is coming. There is no form to send for this appointment. Please call 860-647-4796.
Also complete the Supervisors Accident Investigation; send to HR and Finance. Then report the incident to CIRMA Claim Central as soon as possible. See the link below.
- CIRMA ClaimCentral User Authorization
- CIRMA Supervisor's Accident Investigation Form (PDF)
- CIRMA Injury Reporting Worksheet
- CIRMA Claim Central (Link to claim reporting)
Employee Benefits Forms
- Contact Human Resources for Election Forms
- State of CT Partnership Plan 2.0 Enrollment Form
- State of CT Health Enhancement Program - Physician Notification Form
- Informational
- Life, STD, LTD, AD&D: Mutual of Omaha Designation of Beneficiary Form
- Training and Development Request Form
(also Tuition Reimbursement Request Form) - Employee Assistance Program Brochure
457 Retirement Plan (VOYA)
All Employees are Eligible to Participate in this Retirement Plan
Voya Name Change Document and Instructions. (click here) Fax or mail the completed form with identification to 800-643-8143 or mail it to Voya, One Orange Way, Windsor CT 06095
401a Retirement Plan (VOYA)
- VOYA SELF SERVICE WEBSITE
- 401a Retirement Account Deferred Withholding Form - New Account (PDF)
- Voya Beneficiary Designation - Non-Erisa Form (PDF) or complete the process online (Click Here)
- Voya Name Change Document and Instructions. (click here) Fax or mail the completed form with identification to 800-643-8143 or mail it to Voya, One Orange Way, Windsor CT 06095