Please fill out the forms below and return to HR

Employee Emergency Information Sheet

• Employee Emergency Info Form

Health Enrollment:

• CalPERS Health Enrollment Form - must be done within 60 days of life event
  • Corresponding Cafeteria Plan Form

Dental Enrollment:

• United Concordia Dental Enrollment Form

Vision Enrollment:

(SRFA employees not eligible)

• MES Vision Enrollment/Change Form

Life Insurance:

(for regular employees, greater than 75% FTE)

• Voluntary Life Insurance Application (to purchase coverage for spouse, up to 50% of employee coverage) - must be done within 30 days of life date
• Beneficiary Designation form (for Basic and/or Voluntary Life Insurance)

457 Deferred Comp Beneficiary Designation Forms:

• ICMA
• Nationwide

Marin County Employees' Retirement Association:

• MCERA Beneficiary Change Form (for regular employees, greater than 75% FTE)

PARS:

• PARS Beneficiary Change Form (for part-time & fixed-term employees, less than 75% FTE)