Forms
Human Resources Forms
If you are having trouble locating a form, please call the Human Resources office at 928-213-2090 or ext. 2090.
Employee Forms
- 201 Information Removal Request (PDF)
- 7K Award Nomination Form (DOC)
- Alternate Work Schedule Request Form (DOC)
- Change of Address Form - If you are currently contributing to Arizona State Retirement System (ASRS), you must visit Arizona State Retirement System website to complete an address change with ASRS. Commissioned Fire Fighters and Police Officers must also complete a PSPRS Address Change form.
- City ID Card Request
- City Manager's Employee Excellence Awards Nomination (PDF)
- Donated Leave Request Form (PDF)
- Exit Checklist (PDF)
- Exit Interview Questionnaire
- Request to participate in Holiday Amortization Plan (PDF)
- Nametag Order Form (DOC)
- Outside Employment Information (PDF)
- QSI Award Nomination (DOC)
- Threat Incident Report (DOC)
- Training Enrollment Form
- Tuition Assistance Application (PDF)
- Purchase Day Program (DOCX) - completed and signed forms must be received in Human Resources between May 1st and May 31st for the following fiscal year.
- WOW Award Nomination (DOC)
Payroll Forms
- Leave of Absence Request (PDF) - to request any type of leave.
- Time Missed Overtime / Comp Form (DOC) - if you missed overtime/comp time that should have been on your previous pay check.
- Overtime / Comp Form (DOC) - for overtime/comp time earned this pay period.
- Payroll Cover Form (DOCX)
- Longevity Pay Election Form (DOCX)
- Direct Deposit/PayCard Election Form (PDF) - this form will not be processed without the appropriate documentation:
- Voided check or savings deposit slip; or
- Direct Deposit Form from your bank.
- Form A-4 (Arizona State Tax) (PDF)
- Form W-4 (Federal Tax) (PDF)
- Comp Time Excess Accrual (PDF)
Supervisor Forms
Supervisor Forms for New Hire
- Orientation Checklist (DOCX) - checklist of items to discuss with employee during first week of employment.
- Network access, Naviline and AS/400 access and passwords - Please go to the New Network User Form to complete these forms.
- Nametag Order Form (DOCX) - submit to Human Resources to order a nametag and/or nameplate.
- Cellphone Request - email Liane Garcia
- City Hall after hours FOB - email Roger Carroll
- PC/Laptop Request - email Paul Santana
Volunteer Forms
- Process Outline (PDF)
- Volunteer Consent Form (DOCX) - must be completed by each volunteer annually or when volunteer turns 18, or when type of volunteer service changes.
- Volunteer Tracking Daily Log (DOCX) - for volunteer to sign in/out each time they volunteer. Must be changed daily.
Monthly Report of Volunteers to HR - list each volunteer that donated service during the month. Due to HR by the 5th of the following month.
Benefits Forms
- ASRS Beneficiary Form
- ASRS Enrollment Form
- ASRS Change of Address / Name
- BlueCross / BlueShield Enrollment Form
- BlueCross Reimbursement Form
- Delta Dental Claim Form
- Delta Dental Enrollment Form
- FSA Reimbursement Form - Dependent Care
- FSA Reimbursement Form - Medical
- FSA Reimbursement Form - Orthodontia
- HSA Beneficiary Form
- HSA Enrollment Form
- ICMA Change Form
- VOYA (ING) Change Form
- ICMA Enrollment Form
- ING Enrollment Form
- ING Beneficiary Form
- Minnesota Life Insurability Form
- Minnesota Life Enrollment Form
- Minnesota LIfe Beneficiary Form
- Payroll Deduction Form
- Phased Retirement form (SmartWorks) (DOC)
- PSPRS Name or Address Change
- PSPRS Beneficiary Form
- PSPRS DROP Beneficiary Form
- Tobacco Cessation Reimbursement Form (PDF)
- VSP Claim Form
- VSP Enroll / Change Form
Leave Forms
- FMLA
- FMLA Policy
- FMLA Request Form (PDF)- must be accompanied by one of the following certifications:
- Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
- Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
- Certification for Serious Injury or Illness of Covered Servicemember - or Military Family Leave (PDF)
- Certification of Qualifying Exigency for Military Family Leave (PDF)
- Leave of Absence Request Form (PDF) (for any paid or unpaid leave)
- Request for Donated Leave (PDF)
- Donated Leave Form