Login / Register      

Employee Forms - Human Resources

All forms must be completed by employee and have all necessary accompanying documentation.

For ID badges, report to Operations in room 115.


Retirement Information
Retirement Fact Sheet

BAI - Benefit Administration, Inc.
Employee Health Benefit and Contact Information

AFSCME Address/Name/Dependent Change Forms
AFSCME Employee Update Forms
AFSCME Student Certification Form
* To continue student coverage, please attach copy of schedule or tuition bill.
Erie County Municipality Sheet
AFSCME - Keep Dependent Under 26 on Vision Plan

PSSU Address/Name/Dependent Change Forms
PSSU Employee Update Forms
PSSU Student Certification Form
* To continue student coverage, please attach copy of schedule or tuition bill.
Erie County Municipality Sheet

Non-bargaining and ECAPE Address/Name/Dependent Change Forms
Employee Update Forms
Erie County Municipality Sheet

Medical
PPO Benefit Grid/Provider List
PPO Out of network Claim Forms
Provider Directory

Flex Spending Enrollment and Information
Flex Spending Enrollment and Information

Vision
Vision Description of Benefits
Vision Benefit Request Form
Vision Provider List
Vision Benefits for Non-bargaining, Elected Officials, ECAPE, Detectives, Court Supervisors, Appointed Officials
AFSCME Vision

Prescription
Prescription Mail in Order Form
Prescription Reimbursement Form

Dental
BAI Description of Dental Benefits
BAI Dental Claim Forms
BAI Dental Provider List

Worker's Compensation
Worker Comp. - Notice & Procedures
Worker Comp. - Supervisor Report
Worker Comp. - Incident Report
Worker Comp. - Physician Panel
Worker Comp. - Return to Work Slip
Worker Comp. - Employee Notification

Exit Interview
Exit Interview Policies and Procedures
Human Resources Exit Interview Report

Miscellaneous
I-9 Employment Eligibility Verification Form
Tuition Reimbursement Policy & Forms
Emergency Contact Information
Employee Request To Access Personnel File
Mazzitti & Sullivan Employee Assistance Program
Mercyhurst Employment Verification Form
Life Insurance Change of Beneficiary Form

Employee Personnel Reference Documents
Employee Handbook
Personnel Policies and Procedures
EMTA Shuttle
Tuition Reimbursement Policy
Maternity/Paternity/Adoption Leave Policy
Anti-nepotism Policy


Policies Signed at Hire
Policy 1 - Alcohol, Drugs, and Controlled Substances Prohibition
Policy 3 - Computer Usage Policy
Policy 6 - Drug-Free Workplace
Policy 10 - Equal Employment Opportunity and Affirmative Action
Policy 21 - Workplace Harassment
Policy 36 - Worker's Compensation Policy (Work Related Injury/Illness)

Payroll Forms - Return to Suite 505
W-4 Form
Direct Deposit


Erie County Courthouse - 140 West Sixth Street, Erie, PA 16501 - (814) 451-6000 - TDD Phone: (814) 451-6237 - Hours: Monday through Friday, 8:00am to 4:30pm
Contact Us - Department Listing