Benefits at Los Rios - Forms

• 403B:
  Salary Reduction Agreement Form
  Eligible Companies
• 457:
  Schools Credit Union
  TIAA Cref
  TDS (Security Benefit)
  CalPERS
• FSA:
  Enrollment Form |  Reimbursement Form
• DCAP:
  Enrollment Form |  Reimbursement Form
• VSP:
  Enrollment Form |  Reimbursement Form
• Sick Leave Transfer Request Form
• Sun Life Assurance Beneficiary Form
• Vacation Disposition Form GS#64

Health Insurance Forms

• Domestic Partner Affidavit of Domestic Partnership
• Termination of Domestic Partnership
• Adjunct Insurance Enrollment Certification For #114
• Student Verification Form:
  Kaiser |  Health Net |  PacifiCare
• Insurance Waivers:
  Medical |  Dental
• Insurance Cancellation Request (regular permanent employees):
  Medical |  Dental
• Adjunct Insurance Cancellation:
  Medical |  Dental