FAIRBANKS NORTH STAR BOROUGH

907 Terminal St. Fairbanks AK 99701 (907) 459-1000

Forms

Change of Address / Phone or Other Personal Information

     Conflict of Interest Forms

          COI - Contract Disclosure Form

          COI - Gift Disclosure Form

          COI - Outside Employment Disclosure Form

     Deferred Compensation Forms

          ICMA Forms are available on their website

          MassMutual Forms are available on their website

          MassMutual Change Form

          Nationwide (NACO) Forms are available on their website

Direct Deposit Authorization Form

EAC - Employee Activity Committee Deduction Form

Employee of the Month Nomination Form

     FMLA (Family Medical Leave Act) Information

          Family Medical Leave Request Form (FMLA)

          FMLA Doctor's Certification Forms - Request from HR

Flex Spending/Dependent Care Forms

Flexible Work Option Request Form

     Health Plan Related & Claim Forms

          Caremark Prescription Drug Forms

          Claim Forms - WPAS Medical/Dental/Vision/Prescription

          WPAS Travel Reimbursement Preauthorization Form

          Vision Claim Form - VSP Out-of-Network

How I Would Like to be Paid Form

     Injury & Incident Forms

          Employee Injury Flowchart

          Employee First Aid Injury / Incident Report Form

          Employee Report of Occupational Injury or Illness Form

          Facility User Injury Report Form

          Incident Report Form

          Fitness for Duty Form - Borough

          Fitness for Duty Form - School District

Leave Cash-In Form

Leave Donation Request Authorization Form

Leave Donation Slip Form

      Life Insurance

           Voya Financial Change of Beneficiary Form

           Voya Financial Supplemental & Dependent Enrollment Form

     Management Related Forms

          Applicant Evaluation Form

          Background Investigation Release Form

          Bloodborne Pathogen Vaccination Form

          Computer Use Form

          Counseling Forms

               APEA - Oral Counseling Form

               Laborers' - Oral Counseling Form

               Other - Counseling Form

          Drug Free Workplace Statement Form

          Exit Processing Form

          Flexible Work Option Request Form

          Health Questionnaire

          I-9 Form

          Merit Pay Application Form

          Performance Evaluation Form

          Position Description Questionnaire Form

          Recruitment Requisition Form

          Reference Check Form

          Temporary Pool Request Form

          Temporary Pool Worker Evaluation Form

          Work Improvement Plan

     Motor Vehicle Accident (MVA) Forms 

          Motor Vehicle Accident (MVA) Report Form

          Transit Safety Sensitive Employee Accident Matrix Form

          Public Works Safety Sensitive Employee Accident Matrix Form

          Supervisor's Investigation of MVA Form

NOVATime Forms and Manuals

Overtime / Comp Time Authorization Form

     PERS Beneficiary Form

          Tiers I, II & III

          Tier IV

Release of Employment Information Authorization Form

Report a Safety Concern Form

Sick Leave Bank Sign Up Form

Sick Leave Bank Withdrawal Request Form

Vehicle Expense Report Form

Vehicle Pin Authorization Form

Vehicle Record of Gas Purchase Form

W-2 "Duplicate" Request Form

W-4 Form - 2017