First Day - Bring completed forms
These three forms must be completed and brought with you on your first day of employment.
- I-9 Form, Employment Eligibility Verification (Complete section 1)
You must also bring a copy of your current driver's license and social security card or other acceptable document as noted on the List of Acceptable Documents provided on the form.
- W-4 Form, Employee's Withholding Allowance Certificate
- Employee Emergency Contact Information
First Day - May be partially completed
These forms will be finished with instruction during your orientation session.
Retirement - Washington State Department of Retirement Systems (DRS)
Summary of Benefits and Rates
Enrollment Form and Instructions
AWC Insurance Enrollment Form - Must use full, legal name(s) on all forms. Please attach copies marriage certificate, registered domestic partnership and birth certificate(s) or adoption documentation and copies of Social Security information for all dependents you would like to provide health insurance coverage for.
- Select the "New Hire" option
- Spouse/dependent SSN needed
- Previous Insurance Information needed
- Group Name
- Group Phone Number
- Group Number
- Policy Number
- Effective and Termination Dates
- Complete the "Employee" section and make sure the boxes for medical, dental, vision and EAP are marked with a check mark. If you wish to opt-out of medical, don't check the medical box and discuss at orientation.
- Include information about any previous insurance coverage you have had in the last 3 months.
- DO NOT mark Life and Long Term Disability boxes.
- If you're enrolling a spouse or domestic partner, complete the Affidavit of Marriage/Domestic Partnership form below and circle the one that applies and complete the rest of this section.
- Make sure to mark the type of insurance requested, i.e. medical, dental; vision with a check mark.
- Include marriage license or registered domestic partnership documentation.
- If you're enrolling eligible dependent children, complete the dependent section(s) marking the medical, dental and vision boxes.
- Include information on previous insurance coverage.
- Include copy of birth certificate or adoption documentation and social security card.
- Dependent is an unmarried child or stepchild under the age of 26, unless the child is incapable of self-support due to disabilities.
Life Insurance - Standard Insurance Company
Same form used for both Life and LTD enrollment
Enrollment and Change Form
- Be sure to check the following:
- Life with AD&D Employer Paid
- Dependents Life Employer Paid
- Basic Life
- City pays full premium on the following coverage:
- Employees - $10,000
- Spouse/Domestic Partner or Dependent Child - $1,000
- Additional Life (Optional)
- Employee pays 100% of premium costs for all coverage
- Employees - Increments in $10,000 up to $300,000 maximum
- Spouse/Domestic Partner - Increments in $5,000 up to $150,000 maximum
- Dependent Child - Additional $5,000 maximum
- View important information regarding guarantee issue amounts deadlines
- If new hire applies within 31 days of hire date, the guarantee issue amounts may be increased up to the following amounts without medical history statement:
- Employee - up to $50,000
- Spouse/Domestic Partner - up to $20,000
- Dependent Child - up to $5,000
- After 31 days of hire date
- Must submit medical history statement
- Subject to underwriting
- Medical history statements are sent directly to Standard Insurance Company (do not submit to HR)
Long Term Disability (LTD) - Standard Insurance Company
- Enrollment and Change Form
- Same form used for both Life and LTD enrollment (above)
- Be sure to check the following:
- Basic LTD
- City pays the full premium for basic group LTD coverage.
- Plan requires 180 day waiting period
- Plan pays 50% of pre-disability earnings at time of medical disability
- Enhanced LTD
- Employee pays 100% of premium costs
- Plan requires a 90-day waiting period
- Plan pays 66 2/3% of the first $7,500 of pre-disability earnings at time of medical disability
Equal Employment Opportunity
- EEO form (print, complete and bring to new hire orientation)
Other Optional Benefits
Other benefits provided by the City will be presented at your New Employee Orientation.