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Forms
2017-2018 Health Insurance Open Enrollment Information/Forms
2018 Anthem Enrollment Form.pdf pdf file type icon Download
Branford BOE Administrator HD/HSA Plan Design pdf file type icon Download
Branford BOE BASS HD/HSA Plan Design pdf file type icon Download
Branford BOE Custodians HD/HSA Plan Design pdf file type icon Download
Branford BOE Non-Represented HD/HSA Plan Design pdf file type icon Download
Branford BOE Nurse HD HSA.pdf pdf file type icon Download
Branford BOE Paraprofessionals HD/HSA Plan Design pdf file type icon Download
Branford BOE Teachers HD/HSA Plan Design pdf file type icon Download
Branford BOE Flex Dental Fact Sheet- All Staff pdf file type icon Download

2017-2018 Health Savings Account (HSA) - Connex Credit Union
2017_Health_Savings_Account_Booklet_Final_1.pdf pdf file type icon Download
Connex_HSA_Membership_Application_1.pdf pdf file type icon Download
HSA_Application_1.pdf pdf file type icon Download
HSA_Contribution_Eligibility_Form_1.pdf pdf file type icon Download
HSA_Authorized_User_Form_1.pdf pdf file type icon Download
HSA_Transfer_Request_Form_1.pdf pdf file type icon Download

403B Pre-Tax Savings Information
2018 403b Universal Eligibility Notice pdf file type icon Download

Beneficiary Forms
Mid-America pdf file type icon Download
Municipal Employee Retirement System CO-931-2015 rtf file type icon Download
Sun Life pdf file type icon Download
Teachers Retirement Board pdf file type icon Download

Certified Staff
Applicaton for Professional Certificate Ed-179 pdf file type icon Download
Certification Renewal Ed-126 pdf file type icon Download
Degree Change Step 1 pdf file type icon Download
Degree Change Step 2 pdf file type icon Download

Emergency Information
Employee Emergency Contact Information pdf file type icon Download

General Information
2018-2019 Payroll Schedule pdf file type icon Download

Name/Address Change
Anthem Blue Cross and Blue Shield pdf file type icon Download
Mid-America pdf file type icon Download
Municipal Employee Retirement Form CO-931 2015 rtf file type icon Download
Name/Address Change pdf file type icon Download
Teachers Retirement Board pdf file type icon Download

New Hire Forms
2016 Connecticut W-4 pdf file type icon Download
2016 Federal W-4 pdf file type icon Download
DCF pdf file type icon Download
Direct Deposit xls file type icon Download
Emergency Info Sheet pdf file type icon Download
Kelly Services Schedule Absent Guide pdf file type icon Download
Name/ Address Change pdf file type icon Download
Technology Agreement pdf file type icon Download

Tax Withholding Forms
2018 Connecticut W-4 pdf file type icon Download
2018 Federal W-4 pdf file type icon Download

1111 Main Street | Branford CT 06405 | 203.488.7276

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