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Employment Forms
Here employees have access to HR forms needed to initiate or complete certain personnel tasks. 


  • Accident/Incident Report Form - when an accident or incident occurs, this form needs to be completed by the employee and their supervisor and submitted to HR in accordance with the Incident Policy.
  • ADA Reasonable Accommodation Request Form - any employee who has a disability that may need to request a reasonable accommodation to perform job duties can submit this form to HR or their supervisor.
  • BCBS Health Insurance Change Form  - this is the form that needs to be completed when an employee is requesting a change in their health insurance coverage.
  • Direct Deposit Authorization Form - employees can use this form to change their direct deposit preferences such as changing banks or splitting pay amount into 2 or more separate accounts.
  • Educational Reimbursement Application Form - the City has a budgeted amount for reimbursing employees for education fees.  Employees may use this form for this process in accordance with the Educational Reimbursement Policy.
  • Employee Information Form - It is the employees responsibility to inform the City when they have a change of personal information that affects their employment such as change in address, phone number, marital status, etc.
  • Exit Interview Questionnaire - upon separation of service with the City, HR sends this form to the ex-employee to receive feedback.
  • Flexible Benefits Plan Form - this form is used to request certain amounts being withheld from an employee's paycheck for insurance before their check is taxed. 
  • Flexible Benefits Plan Waiver Form - this form is used to decline the pre-tax option.
  • FMLA Healthcare Certification Form - should an employee need to be absent from work intermittently or consistently for medical reasons, they have the option to request approval for FMLA leave.  This form shall be filled out by the employee's physician to certify the medical condition and need for absence.
  • FMLA Physicians Release Form - this form shall be completed by the employee's physician when the employee is released to return to work.
  • FMLA Physical State for Leave Form - this form shall be completed by the employee's physician and submitted to HR with the FMLA Request form.
  • FMLA Request Form - this form is for the employee to fill out to request FMLA leave.
  • FRS Beneficiary Form - an employee can update their chosen beneficiary at anytime.
  • HRA Claim Form - if an employee is unable to use their HRA Debit Card and has an approved medical expense, they may complete this form and submit it for a reimbursement check.
  • Job Interest Form - if an existing employee is interested in applying for an open position, they do not need to fill out a job application; they may complete and submit this Job Interest Form.
  • Payroll Change Request Form - when notifying the City of changes, employees need to complete this form to submit to HR.
  • Standard Life Insurance Beneficiary Form - an employee can update their chosen beneficiary at anytime.
  • Supplemental Policy Change Form - during our insurance fair each November, employees have the opportunity to meet with several different supplemental insurance carriers.  Should an employee elect to enroll, change, or cancel these policies, this is the form that needs to be completed and submitted to HR.
  • Standard Dental & Vision Change Form - during open enrollment month, November, employees have the option to enroll, change, or cancel their dental and vision policies by completing this form.  Also, if an approved life changing event occurs other effective dates are considered.
  • W4 - an employee can update their W4 information at anytime.



City of DeFuniak Springs • 71 US Hwy 90 West• DeFuniak Springs, FL 32433• 850-892-8500•
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