Birth, Adoption, or Obtain Legal Guardianship of a Child

The following forms need to be completed and turned into Human Resources:

•  Health Insurance Form (with copy of child’s birth certificate)
•  Life Insurance Change of Beneficiary Form
•  PERS Beneficiary Form
•  W-4
The Human Resources Department will notify PERS, Welfare and Pension Administrators, and your Union if you are a member.

Divorce

The following forms need to be completed and turned into Human Resources:
•  Change of Address / Phone or Other Personal Information Form
•  Health Insurance Payroll Deduction Form - FNSB
•  Health Insurance Payroll Deduction Form - Pages
•  Health Insurance Form (with members of the family to be covered after divorce)
•  Life Insurance Change of Beneficiary Form
•  PERS Beneficiary Form (with copy of Divorce Decree/Official Court Affidavits to include QDRO, and Child Support agreement)
•  Social Security Card (with new name, if applicable) must be submitted to HR before name change will take place
•  W-4

The Human Resources Department will notify PERS, Welfare and Pension Administrators, and your Union if a member.

Marriage

The following forms need to be completed and turned into Human Resources:
•  Change of Address / Phone or Other Personal Information Form
•  Health Insurance Payroll Deduction Form - FNSB
•  Health Insurance Payroll Deduction Form - Pages
•  Health Insurance Form (with members of the family to be covered after divorce)
•  Life Insurance Change of Beneficiary Form
•  PERS Beneficiary Form (with copy of Divorce Decree/Official Court Affidavits to include QDRO,
and Child Support agreement)
•  Social Security Card (with new name, if applicable)
•  W-4

Death in your immediate Family or of a Beneficiary

The following forms need to be completed and turned into Human Resources:
•  Health Insurance Payroll Deduction Form - FNSB (if death was a spouse or dependant child and you are not employed as a “Page”)
•  Health Insurance Payroll Deduction Form - Pages (if death was a spouse or dependant child and you ARE employed as a “Page”)
•  Life Insurance Change of Beneficiary Form (if death was a spouse or beneficiary)
•  Life Insurance Claim Form (if your spouse was enrolled in the supplemental life insurance program)
•  PERS Enrollment Form (if death was a spouse)
•  PERS Beneficiary Form (if death was a spouse or beneficiary)
•  W-4