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
Covid 19 Vaccination Accommodation Notification Form Download Accommodation Notification - Adobe PDF  
Reduced Tuition Form    
Electronic First Report of Injury (Web-only Form)    
Paid Family Leave Form Download Reasonable Accommodation Request Form - Adobe PDF Download Reasonable Accommodation Request Form - Microsoft Word Document
Paid Family Leave Form 2023 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  
Family and Medical Leave Act Forms Format: Adobe Format: Word
Family and Medical Leave Request Download Family and Medical Leave Request - Adobe PDF  
FMLA Certification of Health Care Provider for Employee's Serious Health Condition Download FMLA Certification of Health Care Provider for Employee's Serious Health Condition - Adobe PDF Download FMLA Certification of Health Care Provider for Employee's Serious Health Condition - Microsoft Word Document
FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Adobe PDF Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Microsoft Word Document
FMLA Certification of Qualifying Exigency for Military Family Leave Download FMLA Certification of Qualifying Exigency for Military Family Leave - Adobe PDF  
FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave Download FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - Adobe PDF Download FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - Microsoft Word Document
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
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
Reclass a Vacant Position Download Reclass Vacant Position - Adobe PDF
Create a New Position Download New Position Form- Adobe PDF
Career Band Questionnaires (CBQs) (List by Career Families)    
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  
Supervisor Forms Format: Adobe Format: Word
Selection Process Guidelines Download Selection Process Guidelines - Adobe PDF  
Competency Based Selection
Initial Interview Form I   Download Initial Interview Form I - Microsoft Word Document
Final Interview: Form F1   Download Final Interview: Form F1 - Microsoft Word Document
Final Interview: Form F2   Download Final Interview: Form F2 - Microsoft Word Document
Reference Check: Form R1   Download Reference Check: Form R1 - Microsoft Word Document
Reference Check: Form R2   Download Reference Check: Form R2 - Microsoft Word Document
Verification of Education & Experience: Form V   Download Verification of Education & Experience: Form V - Microsoft Word Document
Decision Justification: Form D   Download Decision Justification: Form D - Microsoft Word Document
Authorization for Release of Information Download Authorization for Release of Information - Adobe PDF  
Pay Increase Request Form Download Pay Increase Request Form - Adobe PDF  
Reference Check Forms
Option 1: Employer Reference Check Form Download Option 1: Employer Reference Check Form - Adobe PDF  
Option 2: General Reference Check Form Download Option 2: General Reference Check Form - Adobe PDF  
Requisition Request   Download Requisition Request - Microsoft Word Document
Requisition Request Instructions Download Requisition Request Instructions - Adobe PDF  
Hiring Manager Create Requisition Guide Download Hiring Manager Create Requisition Guide - Adobe PDF  
Seasonal/Temporary Requisition Request   Download Requisition Request - Microsoft Word Document
Intern Request Form   Download Requisition Request - Microsoft Word Document
Risk Management Training Form Download Risk Management Training Form - Adobe PDF  
Volunteer Agreement Download Volunteer Agreement - Adobe PDF  
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