New Hire Forms & Resources
- 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.
BENEFITS-RELATED FORMS (For all benefits-eligible positions)
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.
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 Form: Complete Employee Information section, only.
- DRS Beneficiary Designation Form: Eligible employees, only.
- DRS Plan Enrollment Form: Eligible employees, only.