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Voorheesville Central School District
Employee Forms
2021-22 Blue Shield NENY PPO 815 Benefit Summary
Blue Shield NENY PPO 815 Benefit Summary 21-22.pdf
555.12 KB
(Last Modified on May 5, 2021)
Comments (-1)
2021-22 CDPHP Benefit Summary
CDPHP 21-22 Benefit Summary.pdf
510.88 KB
(Last Modified on May 5, 2021)
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2021-22 ExpressScripts RX
ExpressScripts RX 21-22.pdf
112.67 KB
(Last Modified on May 5, 2021)
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2021-22 HIPAA Authorization
HIPAA AUTHORIZATION 21-22.pdf
105.53 KB
(Last Modified on May 5, 2021)
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2021-22 Health Comparison
21-22 Health Comparison.pdf
130.73 KB
(Last Modified on May 5, 2021)
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2021-22 UEV Health Dental Rates
21-22 UEV HEALTH DENTAL RATES.pdf
53.12 KB
(Last Modified on May 5, 2021)
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2021-22 VTA-VAA Health Dental Rates
21-22 VTA-VAA HEALTH DENTAL RATES.pdf
48.35 KB
(Last Modified on May 5, 2021)
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2021 W4
2021 W4.pdf
4.58 MB
(Last Modified on February 4, 2021)
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2021-22 Waiver of Coverage Confirmation Form
Waiver_of_coverage_confirmation_form 21-22.pdf
82.97 KB
(Last Modified on May 5, 2021)
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FSA Dependent Care
FSA depcare.pdf
254.64 KB
(Last Modified on February 4, 2021)
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Time off to vote form
VoteForm2020.pdf
61.59 KB
(Last Modified on October 7, 2020)
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Information on Emergency Medical Leave Request
Emergency Medical Leave Request Form for Employees.pdf
67.27 KB
(Last Modified on August 24, 2020)
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FFCRA Request Leave Form
FFCRA-Request-for-Leave-Form.pdf
154.86 KB
(Last Modified on August 24, 2020)
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Benetech Flex Spending Enrollment
Benetech Flex Spending Enrollment Form.pdf
186.67 KB
(Last Modified on September 16, 2020)
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Union FAQs for HR
Union FAQs for HR.pdf
106.26 KB
(Last Modified on June 18, 2020)
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2020-21 Pay Date Schedule
20-21 Pay Dates.pdf
5.28 KB
(Last Modified on August 20, 2020)
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2020-2021 Blueshield Benefit Summary
PPO 815 Class 0003.0004 BS - 2020.pdf
555.08 KB
(Last Modified on May 21, 2020)
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HIPPA Authorization
HIPAA AUTHORIZATION.doc
32 KB
(Last Modified on May 21, 2020)
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2021-2020 CAPITAL AREA SCHOOLS HEALTH INSURANCE CONSORTIUM (CASHIC)
CASHIC Enrollment Form with group.pdf
201.33 KB
(Last Modified on May 21, 2020)
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2020 - 2021 Blueshield SBC ASO RX
ASO RX class 0001.0002 SBC.pdf
177.03 KB
(Last Modified on May 21, 2020)
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2020-2021 Voorheesville CSD CDPHP EPO Plan Benefit Summary
2020 Voorheesville CSD Benefit Summary.pdf
196.96 KB
(Last Modified on May 21, 2020)
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Sexual Harassment Policy & Form
Policy 0110. Sexual Harassment Policy 8.26.19.pdf
363.21 KB
(Last Modified on August 29, 2019)
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HRA Direct Deposit
HRA Direct deposit.pdf
50.84 KB
(Last Modified on June 18, 2019)
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BT HRA Expense Recovery Form
BT HRA -- Expense Recovery Form.pdf
183.54 KB
(Last Modified on June 18, 2019)
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FSA HRS Eligible
FSA_HRA_Eligible.pdf
98.46 KB
(Last Modified on June 18, 2019)
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