Forms
If you have problems accessing linked documents on this page, email mrjohnson@sxwx168.net for assistance.
Frequently Requested Forms
- Address Change Form (you must also complete a PA Earned Income Tax Form and send to Payroll)
- Attendance Record 2024 (track paid time off: vacation, personal, sick, etc.)
- Attendance Record 2025 (track paid time off: vacation, personal, sick, etc.)
- Coaching/Performance Review Form
- Gym/Library Application for Spouses
- Payroll Tax Forms
- Timesheet: Bi-weekly
- Timesheet: Monthly
- Tuition Grant Application
- Tuition Remission Form
Medical, Vision and Health Savings Account (HSA)
- Flexible Benefit Plan Election Form
- Blue Cross Medical Enrollment Form
- POS Claim Form
- PPO Out of Network Claim Form
- International Claim Form
- Davis Vision Claim Form
- Health Savings Account (HSA) Election Form
- Health Savings Account (HSA) HealthEquity New Account Form
Dental
Flexible Spending Accounts (FSA)
Please note that while a "paper" claim form is available, it is recommended you submit claims directly through the Inspira Portal.
Life Insurance
- Lincoln Financial Life Insurance Beneficiary Form
- Lincoln Financial Life Insurance Medical Underwriting Application for supplemental insurance
Disability and Other Leaves
Additional Benefits
- Flex-time Request Form
- Gym/Library Application for Spouses
- Tuition Grant Application
- Tuition Remission Form
Employment and Other
- I-9 Employment Eligibility Verification Form
- Address Change Form (you must also complete a PA Earned Income Tax Form and send to Payroll)
- Attendance Record 2025 (track paid time off: vacation, personal, sick, etc.)
- Attendance Record 2024 (track paid time off: vacation, personal, sick, etc.)
- Coaching/Performance Review Form
- Emergency Contact Form
- Employee Information Sheet
- Job Posting Form
- Lactation Space Request Form
- Non-employee Information Sheet (volunteers, research associates, etc.)
- Position Request Form
- Timesheet: Bi-weekly
- Timesheet: Monthly