Forms
| Benefits Claim Forms | Format: Adobe | Format: Word |
|---|---|---|
| HRA & FSA Claim Form | Download HRA & FSA Claim Form - Adobe PDF | |
| 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 | Download Deductible Verification Form - Adobe PDF | |
| Dependent Care Reimbursement Form | Download Dependent Care Reimbursement Form - Adobe PDF |
| Continuous Performance Communication Forms | Format: Adobe | Format: Word | |
|---|---|---|---|
| CPC Summary | Download CPC Preparation Form - Adobe PDF | ||
| CPC Check-in Prep Tool | Download CPC Preparation Form - Adobe PDF | ||
| How to Conduct a CPC Check-in | Download CPC Check-in Document - Adobe PDF | ||
| How to Acknowledge a CPC Check-in | Download CPC Employee Acknowledgement Document - Adobe PDF | ||
| Guidelines for CPC Appraisal Ratings | Download CPC Check-in Document - Adobe PDF | ||
| CPC Appraisal Prep Tool | Download CPC Check-in Document - Adobe PDF | ||
| CPC Appraisal Quick Guide | Download CPC APpraisal Quick Guide Document - Adobe PDF | ||
| How to Conduct a CPC Appraisal | Download How to Conduct a CPC Appraisal FAQ - Adobe PDF | ||
| How to Acknowledge Your CPC Appraisal | Download How to Acknowledge Your CPC Appraisal - Adobe PDF | ||
| CPC Employee FAQ | Download CPC Employee FAQ - Adobe PDF | ||
| CPC Supervisor FAQ | Download CPC Supervisor FAQ - Adobe PDF |
| Employee Forms | Format: Adobe | Format: Word |
|---|---|---|
| Reduced Tuition Form | ||
| Paid Family Leave Form | Download Reasonable Accommodation Request Form - Adobe PDF | Download Reasonable Accommodation Request Form - Microsoft Word Document |
| Reasonable Accommodation Request Form | Download Reasonable Accommodation Request Form - Adobe PDF | Download Reasonable Accommodation Request Form - Microsoft Word Document |
| Outside Employment | Download Outside Employment - Adobe PDF | |
| Request for an Alternative Work Schedule | Download Request for an Alternative Work Schedule - Adobe PDF | Download Request for an Alternative Work Schedule< - Microsoft Word Document |
| State of SD Release and Waiver - Employment Reference Release | Download State of SD Release and Waiver - Employment Reference Release - Adobe PDF | |
| Conflict of Interest Waiver Instructions and Form | Download Conflict of Interest Waiver Instructions and Form - Adobe PDF | |
| Conflict of Interest Matrix | Download Conflict of Interest Matrix - Adobe PDF |
| Health and Flexible Benefits | Format: Adobe | Format: Word |
|---|---|---|
| FY24 Benefits Guide | FY22 Benefits Guide - Adobe PDF | |
| Biometric Screening Form | FY22 Benefits Guide - Adobe PDF | |
| Tobacco Use Election Form | Download Tobacco Use Election Form - Adobe PDF | |
| Wellmark Appeal/Review Form | Download Second Level Appeal External Review Form - Adobe PDF | |
| External Review Experimental Review Form | Download External Review Experimental Review Form - Adobe PDF | |
| External Review Expedited Review Form | Download External Review Expedited Review Form - Adobe PDF | |
| New Health Insurance Marketplace Coverage Options and Your Health Coverage | Download New Health Insurance Marketplace Coverage Options and Your Health Coverage - Adobe PDF |
| How To Guides | Format: Adobe | Format: Word |
|---|---|---|
| Employee Space Quick Reference Guide | Download Employee Space Quick Reference Guide - Adobe PDF | |
| Manager Space Quick Reference Guide | Download Manager Space Quick Reference Guide - Adobe PDF | |
| Manager Space Disposition Quick Reference Guide | Download Manager Space Disposition Quick Reference Guide - Adobe PDF | |
| Proxy Management Quick Reference Guide | Download Proxy Management Quick Reference Guide - Adobe PDF | |
| Tobacco Free Q&A | Download Tobacco Free Q&A - Adobe PDF |
| Pharmacy | Format: Adobe | Format: Word |
|---|---|---|
| Wellmark Drug Formulary Search | Download CVS Participating Pharmacies - Adobe PDF |
| Payroll | Format: Adobe | Format: Word |
|---|---|---|
| Direct Deposit Form | Download Direct Deposit Form - Adobe PDF | |
| Request to Receive Donated Leave | Download Request to Receive Donated Leave - Adobe PDF | |
| Request for an Alternative Work Schedule | Download Request for an Alternative Work Schedule - Adobe PDF | Download Reasonable Accommodation Request Form - Microsoft Word Document |
| Classification Forms | Format: Adobe | Format: Word | Reclass a Vacant Position | Download Reclass Vacant Position - Adobe PDF |
|---|---|---|
| Create a New Position | Download New Position Form- Adobe PDF | |
| Position Description Questionnaire (PDQ) Employees Section | Download Position Description Questionnaire (PDQ) Employees Section - Adobe PDF | |
| Position Description Questionnaire (PDQ) Supervisor's Section | Download Position Description Questionnaire (PDQ) Supervisor's Section - Adobe PDF | |
| Reclassification for Certification Promotional | Download Reclassification for Certification Promotional - Adobe PDF | |
| Career Band Questionnaires (CBQs) (List by Career Families) | ||
| Accounting | ||
| Attorney | ||
| Engineering | ||
| Environmental Science | ||
| Information Technology | ||
| Nurse |
| Seasonal/Temporary | Format: Adobe | Format: Word | |
|---|---|---|---|
| Seasonal/Temporary Job Application | Download Seasonal/Temporary Job Application - Adobe PDF | ||
| Seasonal/Temporary Requisition Request | Download Requisition Request - Microsoft Word Document |
| Workers' Comp | Format: Adobe | Format: Word |
|---|---|---|
| To file your First Report of Injury, please call 888.585.5075 | ||
| First Fill Instructions for RAS | Download Workers' Compensation Direct Deposit Form - Adobe PDF | |
| Workers' Compensation FAQ | Download Workers' Compensation Claim Procedures - Adobe PDF | |
| Workers' Compensation Program Sick and Vacation Leave Form | Download Workers' Compensation Program Sick and Vacation Leave Form - Adobe PDF |