Benefits Claims Forms | Employee Forms | FMLA Forms | Health and Flex Benefits Forms | How To Guides | Pharmacy Forms |
Payroll Forms | Classification Forms | Seasonal/Temporary Forms | Supervisor Forms | Workers' Comp Forms

 

• HRA & FSA Claim Form
• Accident Insurance Claims Process
• Dependent Spending Account Recurring Claim Form
• Hospital Indemnity Insurance Claims Process
• Health Claim Form
• Short Term Disability
• Vision Out of Network Claim Form
• Deductible Verification Form
• Dependent Care Reimbursement Form

Employee Forms

• Reduced Tuition Form
• Paid Family Leave Form PDF | Paid Family Leave Form Word Doc
• Reasonable Accommodation Request Form PDF
• Outside Employment
• Request for an Alternative Work Schedule PDF | Request for an Alternative Work Schedule Word Doc
• State of SD Release and Waiver - Employment Reference Release
• Conflict of Interest Waiver Instructions and Form
• Conflict of Interest Matrix

Family and Medical Leave Act Forms

• FMLA Certification of Health Care Provider for Employee's Serious Health Condition
• FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition
• FMLA Certification of Qualifying Exigency for Military Family Leave
• FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave
• FMLA Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

Health and Flexible Benefits

• Biometric Screening Form
• Tobacco Use Election Form
• Wellmark Appeal/Review Form
• External Review Experimental Review Form
• External Review Expedited Review Form
• New Health Insurance Marketplace Coverage Options and Your Health Coverage

• Employee Space Quick Reference Guide
• Manager Space Documents
• Manager Space Disposition Quick Reference Guide
• Proxy Management Quick Reference Guide
• Tobacco Free Q&A

Pharmacy

• Wellmark Drug Formulary Search

Payroll

• Direct Deposit Form
• Request to Receive Donated Leave
• Request for an Alternative Work Schedule PDF | Request for an Alternative Work Schedule Word Doc

Classification Forms

• Reclass a Vacant Position
• Create a New Position
• Position Description Questionnaire (PDQ) Employees Section
• Position Description Questionnaire (PDQ) Supervisor's Section
• Reclassification for Certification Promotional

Career Band Questionnaires (CBQs) (List by Career Families)

• Accounting:  Acct Supervisor | Act Employee Level 2 or Above | Acc Employee Level 1
• Attorney: Att Supervisor | Att Employee Level 2 or Above | Att Employee Level 1
• Engineering: Eng Supervisor | Eng Employee Level 2 or Above | Eng Employee Level 1
• Environmental Science: Env Supervisor | Env Employee Level 2 or Above | Env Employee Level 1
• Information Technology: IT Supervisor | IT Employee
• Nurse – Nurse Supervisor | Nurse Employee Level 2 or Above | Nurse Employee Level 1

Seasonal/Temporary

• Seasonal/Temporary Job Application
• Seasonal/Temporary Requisition Request

Supervisor Forms

• Pay Increase Request Form
• Requisition Request
• Requisition Request Instructions
• Hiring Manager Create Requisition Guide
• Seasonal/Temporary Requisition Request
• Intern Request Form
• Risk Management Training Form
• Volunteer Agreement

• To file your First Report of Injury, please call 888.585.5075
• First Fill Instructions for RAS
• Workers' Compensation FAQ
• Workers' Compensation Program Sick and Vacation Leave Form