Resources
Human Resources
Please use the information below to access forms or websites that you may need to learn about your benefits and make changes if needed. If you have questions, please contact us by using the contact form at the bottom of the page.
Forms and Resources
Blue Cross Application: Use this form to make changes to your Blue Cross Health Insurance Plan
CHIP Notice: Federal form regarding potential state assistance with healthcare premiums Spanish CHIPRA
Direct Deposit: Use this form to authorize payroll payments directly to your bank accounts
Education Foundation Deduction: Use this form to donate part of your paycheck to the Jefferson Education Foundation
EOBs for Buy Down: Information for submitting Explanation of Benefits forms for the Buy Down Program
Flex Reimbursement: Use this form if you have a Section 125 Flex account
Glossary of Health Coverage and Medical Terms
Healthcare Exchange Notice: Federal form notice regarding the district’s health plan
Healthy Measures Application: Use this form to apply to participate in the Healthy Measures Buy Down Program
Life Map Beneficiary: Use this form to change those designated as beneficiaries for Life Map insurance.
Group Health Plan Notices and Medicare D Notice for Plan Participants: English Participant
Payroll Deduction Authorization: Use this form to make changes to an authorized payroll deduction
PERSI 401k: Use this form for PERSI Choice 401k Plan changes
PERSI Beneficiary: Use this form to change those designated as beneficiaries for PERSI
W-4 Changes: Login to iVisions to change your number of deductions on your W-4
Additional Links for More Information
Certified Salary Schedule 2023-24
Classified Salary Schedule 2023-24
Health Insurance Benefit Summary
For additional questions you may contact the Human Resources and Payroll Department using the form below.