Treasurer's Forms

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Treasurer's Forms

PLEASE RETURN ALL FORMS TO THE ERVING TREASURER'S OFFICE!

EMPLOYEE FORMS

W-4 (Employee Withholding Allowance Certificate)

M-4 (Massachusetts Witholding Allowance Certificate)

I-9 (Employment Eligibility Verification Form)

Statement Concerning Your Job Not Covered Under Social SecurityMasschusetts

Payroll Direct Deposit Form

HEALTH, RETIRMENT AND INSURANCE FORMS

Mandatory Heath Care Forms

     -Eligible (20 or More Hours per Week)

     -Non-Eligible (Less Than 20 Hours per Week)

Guardian Dental Insurance Enrollment Form

BC/BS OF Massachusetts Health Insurance Enrollment Form

Adult Children (19 - 26 years old) Form

Boston Mutual Life Insurance/Long Term Disability Or Accidental Death and Disability

Franklin Regional Retirement Application

OBRA Form and Information

       -OBRA Acknowledge Form

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age, or disability.

(Not all prohibited bases apply to all programs.)

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights,1400 Independence Avenue, S.W., Washington, D.C. 20250-9410,

or call (800) 795-3272 (voice), or (202) 720-6382 (TDD).