HR Forms
 

INSTRUCTIONS: Please make sure to submit copies of all completed forms directly to HR.

 

ADDRESS CHANGE FORMS (please also make sure to notify HR as well so that your information may be updated with our MEBT recordkeepers and in our payroll system):

 AWC (health insurance) form

Deferred compensation (requires direct notification by you to your dcp provider- see the deferred compensation tab for contact information)

 

Emergency Contact Personnel File Information form

DRS state retirement system (PERS & LEOFF) form

 

BENEFICIARY CHANGE FORMS (please also make sure to notify HR)

Cigna Life Insurance, LTD & AD & D form

Cigna Life Insurance beneficiary form ($100,000 MEBT death benefit)

W-4 (optional)

MEBT beneficiary form

DRS state retirement (PERS & LEOFF) beneficiary form

 

MARRIAGE/DISSOLUTION OF MARRIAGE/REGISTERED DOMESTIC PARTNERSHIP FORMS (please also make sure to notify HR)

See Beneficiary Change Forms above

AWC (health insurance) enrollment form -adding (spouse, registered domestic parter and/or dependents) or removing a former spouse, registered domestic partner and ineligible dependents)

 

Payroll Deduction Change Forms 

Direct Deposit

DRS - Deferred Compensation (Police only. Use this form if you need to change your Department of Retirement Services Deferred Compensation contribution. City's contribution will not change)

 

MEBT Contributions

 

ICMA-RC Amount of Deferral Change Form

Human Resource Contact

Contact Information: Please contact the Human Resources Department

Phone: 425-771-0258
Fax:   425-275-4806
maryann.hardie@edmondswa.gov