Current Employee Forms
Most forms are in the interactive PDF format. If further assistance is required, please contact the Benefits Office at (209) 575-6547.
For more information on District Benefits, access the applicable link on the left side navigation bar.
Address Change Form (Mailing address/legal residence - documentation may be required)
SISC III Change Form (Name, marital status, dependent eligibility)
Note: Changes must be submitted with appropriate documentation within 31 days of event (marriage, birth, etc.).
Payroll Authorization Form (POP form) - (required for 80%-C, 90%-G, or 100%-D plan choices)
Blue Shield PPO Medical Claim Form (Medical bills reimbursement)
Navia Flex Spending Account (Link to Website) - Contact Payroll Department at (209) 575-6538 for more information.
Be sure to check www.DeltaDentalIns.com to see if your dentist accepts the Premier/Incentive plan or the PPO plan.