New Hire Forms & Resources

All new hires must complete and sign the forms relevant below and return them to HR within the first 3 days of work start date. Forms (except I-9) may be completed electronically and emailed to hr@sanjuanco.com or completed manually and delivered in person during New Hire Orientation.

PAYROLL FORMS

- I-9 FORM: Please bring the I-9 and your valid US Passport or Driver's License and Social Security Card to your New Hire Orientation. Original ID are required; facsimiles cannot be accepted. Please see form for full list of alternative documents.

- W-4 FORM

DIRECT DEPOSIT AND DRAW REQUEST FORMS: Forms will be provided via email or in-person during New Hire Orientation. Please bring a voided check or other memo that includes your name, account number, and routing number (such as the top of your bank statement) to your scheduled orientation.

- Employee Information, Emergency Contact and EEO Form

- Employee Confidentiality & Privacy Agreement Form

BENEFITS-RELATED FORMS (For all benefits-eligible positions)

Health Benefits under the Public Employees Benefits Board (PEBB).

Note: You may waive medical benefits, but not dental. You must do so via the enrollment forms below. Eligible employees must submit completed enrollment forms within 31 days of hire. Coverage will be effective for all eligible employees on the 1st of the month following eligibility date (typically 1st day of hire).

- PEBB Enrollment Guide: Includes Benefits Summaries and Premiums. San Juan County employees may choose from three plans under Uniform Medical Plan (UMP): UMP CDHP (High Deductible plan*), UMP Classic or UMP Select.

- 2023 PEBB Enrollment/Change Form: UMP CDHP comes with a Health Savings Account (HSA). CDHP subscribers must also complete the HSA Enrollment Form. 2024 PEBB Enrollment/Change Form available here.

- PEBB Long-Term Disability Form: Accept default enrollment to 60% plan, change to 50% plan or decline. Plan details are available at this web link. IMPORTANT: If you do nothing, you will automatically be enrolled in the 60% LTD plan.

- MetLife Life Insurance Form: Accept default enrollment to Basic plans or add supplemental plans. Plan details are available at this web link.

- PEBB Dental Dental Plans and Benefits: Use the PEBB Enrollment Form to make your plan selection.

Retirement benefits under Department of Retirement Systems (DRS) Public Employees Retirement System (PERS)

Please complete and sign all applicable forms below. Eligible employees must submit completed enrollment form within 90 days of hire or be defaulted to Plan 2, permanently. Eligibility is based on position details; Must be anticipated to work at least 70 hours/month for 5 months during a 12-month period, for at least 2 consecutive years.

- DRS Plan Information for New (Eligible) Employees: Includes summaries of Plan 2 and Plan 3.

- DRS Retirement Status Verification Form: Complete Employee Information section, only.

- DRS Beneficiary Designation Form: Eligible employees, only.

- DRS Plan Enrollment Form: Eligible employees, only.

Air Ambulance Insurance (Paid for by San Juan County)

- Airlift Northwest Member Form

- Island Air Group Member Form

- Life Flight Network Member Form

Deferred Compensation Programs (DCP) - 457b Optional Retirement Plans

Investment options are mutual funds, a collection of investments that may include stocks and bonds. We offer State DCP and Nationwide.

- DRS Deferred Compensation Information

- DCP Quick Enrollment Form