Employee Forms
Department Heads and Supervisors
- 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.
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
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)