Compensation and Classification Form

• Reallocation Request Form

Employment Application Forms

• Pima County Application
• Pima County Application Continuation Sheet
• Pima County Applicant Change Form
• Nurse Application
• Attorney Supplemental Application
• Paralegal Supplemental Application
• Coursework Supplement

E-Verify Form

• I-9 Form

Family & Medical Leave Act (FMLA) Forms

• Pima County Family & Medical Leave Employee Request
• Fitness for Duty Report
• Employee Rights & Responsibilities Under the Family & Medical Leave Act

Mediation, Grievance and Appeal Forms

• Request for Mediation - Prior To Filing A Grievance
• Request for Mediation - Not Involving A Grievance
• Grievances Not Alleging Discrimination (Merit System Rule 13.2)
• Grievances Alleging Discrimination (Merit System Rule 13.3)
• Merit System Appeal Form (Merit System Rule 14)
• Discrimination Grievance Form - For Unclassified Employees (BOS Policy D.21.3)
• Law Enforcement Employee Grievance Form (Law Enforcement Merit System Rule XIII-2) *
• Law Enforcement Discrimination Grievance Form (Law Enforcement Merit System Rule XIII-3) *
• Law Enforcement Merit System Appeal Form (Law Enforcement Merit System Rule XIII-4) *
  

* These forms are to be used only by Law Enforcement Officers of the Sheriff's Department.

Performance Management Forms

• Performance Plan *
• Performance Appraisal *
• Special Observation Period Appraisal *

* See HR Training & Development / Performance Management page for additional tools and information.

Domestic Partner Forms

• Domestic Partner Affidavit (for insurance related purposes, as well as use of sick leave and humanitarian leave)
  Note: Domestic Partner is covered under Pima County's Insurance Plan.
• Domestic Partner Affidavit (for non-insurance related purposes, only the use of sick leave and humanitarian leave)
  Note: Domestic Partner is not covered under Pima County's Insurance Plan.
  
• Domestic Partner Termination Form

Employee Assistance Program (EAP) Forms

• Authorization to Release Information for Management Referrals
• Confirmation of Attendance for Management Referrals

Health Savings Account (HSA) Forms

• HSA Mistaken Distribution Form
• HSA Payroll Authorization Form - 2010

Life Insurance Forms

• Life Insurance Enrollment Form
• Life Insurance Evidence of Insurability (EOI) Form

Medical / Dental Claim Forms

• Pima County Dental Claim Form
• United Healthcare Claim Form

PO Box 30555
Salt Lake City, UT 84130

• United Healthcare RX Reimbursement Claim Form - Medco RX

Medco Health
P.O. Box 2096
Lee's Summit, MO 64063-7096

Medical/Dental Coverage Forms

• Insurance Coverage Agreement While on Leave Form
• Medical and Dental Insurance Enrollment Form

Section 125 and 132 Forms

• Section 125 - Flexible Spending Account - Claim Form
• Section 125 - Flexible Spending Account - Change in Status Form
• Section 125 and 132 - Direct Deposit Form
• Section 132 - Pre-Tax Parking and Transit - Claim Form
• Section 132 - Pre-Tax Parking and Transit - Enrollment Form