New Hire Forms & Resources

All new hires must complete and sign the forms relevant below and return them to HR within the first 3 days of work start date. Forms (except I-9) may be completed electronically and emailed to hr@sanjuancountywa.gov or completed manually and delivered in person during New Hire Orientation.

PAYROLL FORMS

- I-9 FORM: Please bring the I-9 and your valid US Passport or Driver's License and Social Security Card to your New Hire Orientation. Original ID are required; facsimiles cannot be accepted. Please see form for full list of alternative documents. 

- W-4 FORM

DIRECT DEPOSIT AND DRAW REQUEST FORMS: Forms will be provided via email or in-person during New Hire Orientation. Please bring a voided check or other memo that includes your name, account number, and routing number (such as the top of your bank statement) to your scheduled orientation.

- Employee Information, Emergency Contact and EEO Form

- Employee Confidentiality & Privacy Agreement Form

BENEFITS-RELATED FORMS (For all benefits-eligible positions)

Health Benefits under the Public Employees Benefits Board (PEBB). 

Note: You may waive medical benefits, but not dental. You must do so via the enrollment forms below. Eligible employees must submit completed enrollment forms within 31 days of hire. Coverage will be effective for all eligible employees on the 1st of the month following eligibility date (typically 1st day of hire). 

- PEBB Enrollment Guide: Includes Benefits Summaries and Premiums. San Juan County employees may choose from three plans under Uniform Medical Plan (UMP): UMP CDHP (High Deductible plan), UMP Classic or UMP Select.

- PEBB Medical and Dental Enrollment: Newly eligible employees can choose to sign themselves up for medical and dental plans via PEBB's online enrollment system, Benefits 24/7. Please review the How to use Benefits 24/7 document for further instructions. Note: you will not be able to enroll until Human Resources has added you as a subscriber. Employees may also opt to select their plans using the 2024 PEBB Enrollment/Change Form. UMP CDHP includes a Health Savings Account (HSA). CDHP subscribers can complete the HSA Enrollment Form to add individual contributions. 

- PEBB Long-Term Disability enrollment can also be processed through Benefits 24/7. Alternatively, new employees can utilize the PEBB LTD Enrollment Form to complete this. Employees must accept default enrollment to 60% plan, change to 50% plan, or decline. Plan details are available at this web link. Please note that failure to select one of these options will result in an automatic enrollment to the 60% plan. 

You can calculate your benefit and premium cost through Benefits 24/7. Alternatively, you can use the Supplemental LTD Premium Calculator. Please contact Human Resources if you need assistance with the calculation.

- MetLife Life Insurance Form: Accept default enrollment to Basic plans or add supplemental plans. Plan details are available at this web link.

- PEBB Dental Dental Plans and Benefits: Use Benefits 24/7 or the PEBB Enrollment Form to make your plan selection.

Retirement benefits under Department of Retirement Systems (DRS) Public Employees Retirement System (PERS)

Please complete and sign all applicable forms below. Eligible employees must submit completed enrollment form within 90 days of hire or be defaulted to Plan 2, permanently. Eligibility is based on position details; Must be anticipated to work at least 70 hours/month for 5 months during a 12-month period, for at least 2 consecutive years.

- DRS Plan Information for New (Eligible) Employees: Includes summaries of Plan 2 and Plan 3. 

- DRS Retirement Status Verification FormComplete Employee Information section, only.

- DRS Beneficiary Designation Form: Eligible employees, only.

- DRS Plan Enrollment Form: Eligible employees, only.

Air Ambulance Insurance (Paid for by San Juan County)

- Airlift Northwest Member Enrollment Form

- Island Air Group Member Enrollment Form

- Life Flight Network Member Enrollment Form

Deferred Compensation Programs (DCP) - 457b Optional Retirement Plans 

Investment options are mutual funds, a collection of investments that may include stocks and bonds. We offer State DCP and Nationwide.

- DRS Deferred Compensation Information

- DCP Quick Enrollment Form

- Nationwide Deferred Compensation Program Information

- Nationwide DCP Enrollment Online Form

Sheriff's Guild Additional Benefits Forms

- HRA VEBA Enrollment Form

- LTD, Life, and AD&D Enrollment Form

- WACOPS LTD, Life, and AD&D Enrollment Form