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School District of Janesville

Departments * Administrative and Human Services * Employee Forms

Employee Forms

Subfinder Tutorial For Staff

This link will be provided by September 2016.

 

Employee Access

Employee Access Check Viewing Instruction Sheet
Employee Access Time Off Instructions


Applying for an Internal Position

Questions? Please contact the Human Resources Department at extension 5024 or extension 5026.

Internal Applicants should apply online through the WECAN website.  Applicants should change their Internal Applicant Info to reflect they currently work for the School District of Janesville and enter their district email.  This should be done prior to applying for any vacancy to ensure you are indicated as an internal candidate.

 

Starting or Changing Tax Shelter Annuity

Questions? Call Sue Winter at extension 5052

The district will help you save for your retirement with a retirement savings program. We will deduct an amount you specify from your paycheck and make automatic deposits to a pre-tax 403(b), after tax ROTH 403(b), after tax 457 ROTH or pre-tax 457 Deferred Compensation plan.

You can select from two venders to get started into a savings program.  Contact either Retirement Plan Advisors (RPA) at 608-531-0190 or WEA at 800-279-4030 to receive information about their plans and the appropriate forms.

To change the deduction amount of an existing plan, please forward the Salary Reduction Agreement form to the Payroll Department.

To change the distribution of funds within your current plan, call either RPA or WEA at the above numbers.

Salary Reduction Authorization for 403(b)
Salary Reduction Authorization for Roth 403(b)
Salary Reduction Authorization for 457(b) Deferred Compensation Plan
Salary Reduction Authorization for Roth 457(b)


Change your Choice of Payment for the following year

Changes to Choice of Payments must be submitted to the Human Resource Department.  Please check forms for specific timelines.  Changes can not be made during the school year.  Questions?  Please contact Michelle Kahl at extension 5024 or Nichole Conaway at extension 5026.

Certified Staff Choice of Payment Form
Classified Staff Choice of Payment Form
Elementary Building Secretaries Choice of Payment Form


Direct Deposit

Questions? Call Sue Winter at extension 5052

We will direct deposit your paycheck to one financial institution of your choice. Please complete the Direct Deposit Authorization Form and forward to the Payroll Department. Don’t forget to attach a voided check!

Direct Deposit Authorization Form


Requesting a Chance of a Lifetime Leave

Questions? Call Michelle Kahl at extension 5024.

After your supervisor has approved your request, the form below should be forwarded to the Human Resource Department for final approval. The form should be submitted by the 10th workday of the school semester in which you are requesting the leave.  Please refer to the Employee Handbook section 10.08 for specific information regarding this leave.

Chance of a Lifetime Leave Form


Earned Release Time

Questions? Call Michelle Kahl at extension 5024.

To use Earned Release Time, keep track of your hours on an Earned Release Time Sheet and submit to your supervisor. The dates that ERT can be used this year are located on the time sheet also.

Earned Release Time Sheet


Change of Name/Address

Questions? Call Michelle Kahl at extension 5024.

Please complete this form if you have moved or changed your name and forward to the Human Resource Department. If you have moved due to marriage or divorce, please see the section labeled "Change in Marital Status".  If your legal name will be changing for any reason, a copy of the legal documentation (marriage license, divorce decree, etc) will be needed prior to the name change being completed.  Additionally, the Benefits Department will need a copy of your new Social Security Card with the updated legal name.

Change of Name/Address Form


Change in Tax Withholding

Questions? Call Sue Winter at extension 5052

If you need to change the amount of taxes withheld from your paycheck, please complete the following form and forward to the Payroll Department. Please complete only the Federal W-4 Form if you would like both state and federal withholding to be the same. If you would like Wisconsin withholding to be different, you should complete the Wisconsin Withholding form found below.

Federal W-4 Tax Withholding Form
Wisconsin W-4 Tax Withholding Form


Change in Marital Status

Questions? Call Mandy Harper at extension 5021 or Jamie Brown at extension 5007.

Please be sure to complete the following forms and submit to the Employee Benefits department within 30 days of your change in status. In addition to your district benefits, you probably would like to change the beneficiary for your state retirement account also. To do this, contact the Wisconsin State Retirement System at 1-877-533-5020.  If your legal name will be changing for any reason, a copy of the legal documentation (marriage license, divorce decree, etc) will be needed prior to the name change being completed.  Additionally, the Benefits Department will need a copy of your new Social Security Card with the updated legal name.

Change of Name/Address Form
Health and Dental Enrollment Application Form
Federal W-4 Tax Withholding Form
Wisconsin W-4 Tax Withholding Form
Life Insurance Beneficiary Designation Form


Flexible Benefit Claim Submission

Questions? Call Mandy Harper at extension 5021.

If you are a member of our Flexible Benefit Plan with Diversified Benefit Services, please submit the following form with your receipts. If they receive your claim by the 5th of the month, they will write you a check on the 10th of the month. If they receive your claim by the 20th of the month, they will write you a check on the 25th of the month.

Flexible Benefit Plan Claim Form 
Link to Diversified Benefits Website - www.dbsbenefits.com (our Customer Name: Janesville and Pin Number: J98V43L9)

 

Changes in Dependents on your Health Plan

Questions? Call Mandy Harper at extension 5021 or Jamie Brown at extension 5007.

Please complete the attached form and send to Employee Benefits if you have added dependent children to your health plan through birth or adoption or if your children over the age of 19 are no longer attending college full-time. A new form is required each time you change dependents and needs to be submitted within 30 days of the change.

Health and Dental Enrollment Application Form


Changing your Life Insurance Beneficiary

Questions? Call Mandy Harper at extension 5021 or Jamie Brown at extension 5007.

If you would like to change the beneficiaries to your life insurance, please print the following form and submit to Employee Benefits. You can also change the beneficiary to your retirement funds in the Wisconsin State Retirement System by calling 1-877-533-5020.

 Mutual of Omaha Insurance Beneficiary Designation


Health Insurance for Adult Children Up to Age 26

Effective September 1, 2012, the School District of Janesville will cover dependents to age 26 under the provisions of the Patient Protection and Affordable Care Act (PPACA).  If you are interested in enrolling your eligible dependent under the Dependent Insurance Coverage provision, please contact Mandy Harper at extension 5021 or mharper@janesville.k12.wi.us.

Dependent Verification Form


Domestic Partner Affidavit

Please complete this form and return to the Human Resource Office if you would like to register a domestic partnership with the District. If this form is on file in HR prior to the absence, you may use family illness days for domestic partners. 

Affidavit

 

Waiver of Health/Prescription Drug/Dental Coverage

All eligible employees must either enroll in or waive health/prescription drug/dental benefits within 30 days of employment or at the annual open enrollment. To waive your benefits, please complete this form and return it to the Employee Benefits Department.

Heath and Dental Application Enrollment Form and Waiver


Employee Assistance Program

Questions?  Call Employee Benefits at extension 5021 or  5007.

Employee Assistance Program Information