Burlington School District Home Page
Human Resources Files
Employee Forms
 NameCreatedAction
6) 403b Retirement Savings Plan.pdf1/13/2016
ACA FLSA plan summary.pdf
American Care Act Health Insurance Plan Information for BSD
10/4/2013
City Retirement Information.pdf7/13/2011
DECLARATION OF HEALTH CARE FORM 1516.pdf
DECLARATION OF HEALTH CARE FORM 2015 - 2016
5/18/2015
dental form (1).pdf
CIGNA DENTAL ENROLLMENT / CHANGE FORM
12/1/2015
Direct Deposit Form District Website June 2012.pdf6/7/2012
Driver Information Form 2.16.15.pdf2/17/2015
EAP Employee Assistance Program BROCHURE.PDF
EAP - Employee Assistance Program Contact Info. Free for all employees and members of their household. Confidential referrals.
8/6/2015
Fingerprint Procedure 08 12 REV.pdf11/14/2012
Group_Enrollment_Form.pdf
BC BS Group Enrollment / Change Form
10/11/2012
J PLAN.VEHI SUMMARY OF BENEFITS 0715.pdf
J Plan VEHI BC/BS Limited as an option for some employee groups, Blue Cross Blue Shield Summary of Benefits for VEHI J Plan
7/29/2015
Leave Request Form Teachers and Paraeducators.pdf10/29/2015
LIFE INSURANCE Enrollment Form Horace Mann.pdf
LIFE INSURANCE Enrollment form. Horace Mann
5/14/2015
LIFE INSURANCE form Beneficiary change Horace Mann.pdf
LIFE INSURANCE Beneficiary Change Form
5/14/2015
MilLeaveShortForm.pdf7/13/2011
Para Credit Pre-Approval Form.pdf7/13/2011
Procurement Procedures.pdf3/4/2016
Professional Development Substitute Request Form.pdf9/30/2015
Section 125 Forms Kit.pdf5/6/2016
Section 125 Information Letters.pdf5/6/2016
Section 125 Plan Summary Plan Description.pdf5/12/2015
Teacher Evaluation Forms.pdf7/13/2011
Teacher Lateral Move Form.pdf7/13/2011
Teacher License NameAddress Change Form.pdf7/13/2011
TRAVEL EXPENSE REIMB FORM 01.01.15 (1).pdf2/6/2015
TRAVEL Mileage Form 01.01.16.pdf8/29/2016
Travel Procedures Information.pdf7/13/2011
Tuition Reimbursement in plain English.pdf
Guide on Tuition Reimbursement
9/1/2016
Tuition Reimbursement Request Form.pdf
Tuition Reimbursement Form
8/14/2015
UVM Libraries Authorization Form (1).pdf
BSD Staff may use this for access to the UVM library.
8/28/2013
VEHI COMP 300 DUAL OPTION BCBS SUMMARY OF BENEFITS 070115.pdf
Blue Cross Blue Shield VEHI Comprehensive DUAL Option 300 Deductible Summary of Benefit Description
7/29/2015
VEHI VHP BCBS SUMMARY OF BENEFITS 070115.pdf
VEHI-VHP Blue Cross Blue Shield Summary of Benefits for the Vt. Education Health Care Initiative VHP BC/BS Insurance option. This is by far the most popular election of coverage for our employees.
7/29/2015
VEHI_201516_Active_Booklet_FINAL1516.pdf
VEHI VHP PLAN BC BS HEALTH INSURANCE DETAILED BOOKLET 2015
5/14/2015
W-4 Form 2017.pdf
Form W-4, Employee's Withholding Allowance Certificate. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.
2/14/2017
W-9 REQUEST FOR TAXPAYER ID CERTIFICATION.pdf
Form W-9, Request for Taxpayer Identification Number (TIN) and Certification
Use this form to provide your correct TIN to the entity who is required to file an information return with the IRS.
8/6/2014
WC 1ST REPORT OF INJURY CMUTUAL.pdf
First Report of Injury form that employees fill out ASAP if they get hurt at work.
8/11/2016
WC CONCENTRA MAP.pdf
DIRECTIONS TO CONCENTRA, THE HEALTH PROVIDER THAT YOU ARE DIRECTED TO FOR THE FIRST VISIT FOR WORK INJURIES THAT ARE NON LIFE THREATENING.
8/11/2016
WC Employee Responsibilities.pdf
Instructions on what to do if you are hurt at work.
8/6/2015
WC FLOWCHART EE.pdf8/16/2013
WC Form 8 change Dr.pdf
You will need this form to change your health care provider for worker's compensation case.
8/6/2015
WC WORK INJURY COMPLETE FORM PACKET.pdf
Complete set of forms needed for when an employee is injured at work.
8/11/2016