Forms

General

22-26 Pays Election Form

Emergency Contact Form

Employee Retirement/Resignation Form

Extension of Employment Form

Grievance Procedure

Name/Address/Phone Number Change Form

MESPA Tuition Reimbursement Form

Position Justification Form

Salary Adjustment Form (SEA)

Wage Adjustment Form (ESOS, MESPA)

 

Workers' Compensation

Employee Injury Report Form (to be completed by Employee)

Employer Basic Report of Injury Form (to be completed by Building Administrator)

Instructions for Completing the Employer Basic Report of Injury Form

 

Appendix B

Appendix B Agreement (.pdf)

Appendix B Agreement (.docx)  

 

Leave Request Forms

Used for an absence of five (5) or more days.  Must be turned in to Human Resources for approval.
ESOS, MESPA, SASA, SEA, UNAFF

 

Leave Extension Request Forms

Used to extend a current leave of absence.  Must be turned in to Human Resources for approval.
ESOS, MESPA, SASA, SEA, UNAFF

 

ESOS

Compensatory Time Form

Secretarial Overtime & Extra Help Request Form

 

Insurance

SASA/UNAFF/UNAFT Mutual of Omaha Life Insurance Beneficiary Designation Form

MESSA Member Change Form
Used to add/remove dependents/optional benefits or name/address changes.

MESSA Member Application
Used to re-instate recalled employees and to switch from Pak A (full coverage) to Pak B (no medical).

MESSA CIGNA Life Insurance Beneficiary Designation Form

MESSA CIGNA Life Insurance Beneficiary Address Form

MESSA COBRA Application
Used to elect employee paid group health coverage.

 

EduStaff

Performance Feedback / Corrective Action Form

 

SEA

Teachers Move Compensation Form