HR Forms

Beneficiary Forms

  1. AFLAC (PDF)
  2. Colonial (PDF)
  3. CHUBB Insurance (Police & Fire Only) (PDF)
  1. Fire Pension (PDF)
  2. General Employees Pension (PDF)
  3. Police Pension (PDF)
  1. Standard Life Insurance (PDF)
  2. VOYA - 457 Plan (PDF)

Benefit Claim Forms

  1. AFLAC: Accident Claim Form (PDF)
  2. AFLAC: Accident Wellness Claim Form (PDF)
  3. AFLAC: Cancer Wellness Claim Form (PDF)
  1. AFLAC: Hospital Indemnity Claim Form
  2. AFLAC: Hospital Wellness Claim Form (PDF)
  3. OptumRX Mail Order Form (PDF)
  1. WageWorks: Dependent Care Claim Form (PDF)
  2. WageWorks: Health Claim Form (PDF)

Miscellaneous Forms

  1. Access Card Agreement (PDF)
  2. Additional Employment Outside Town of Davie (PDF)
  3. Address Change Form (PDF)
  4. Cell Phone Stipend Agreement (PDF)
  5. Checklist: Employee Separation (PDF)
  6. Checklist: New Employee (PDF)
  7. Conflict of Interest Declaration Form (PDF)
  8. Corrective Action Form (PDF)
  9. Dating Disclosure Form (PDF)
  1. Donation of Leave Time (PDF)
  2. EEO Form: Notice of Discrimination Complaint (PDF)
  3. Employee Counseling/Warning Form (PDF)
  4. Employee Disciplinary Form (PDF)
  5. Exemption Review Report (PDF)
  6. Exit Interview (PDF)
  7. Leave Authorization (PDF)
  8. Miscellaneous Reimbursement Form (PDF)
  9. Performance Evaluation (PDF)
  1. Pool Vehicle Issue and Return Form (PDF)
  2. Public Records Exemption Form (PDF)
  3. Request For Hire (PDF)
  4. Telecommuting Agreement (PDF)
  5. Temporary Staffing Request Form (PDF)
  6. Town Owned Cell Phone Agreement (PDF)
  7. Tuition Reimbursement Form (PDF)
  8. Veterans Preference Form (PDF)

Payroll Forms

  1. Payroll Direct Deposit Form (PDF)
  1. 2021 Form W-4 (PDF)
  1. 2021 Tax Withholding (PDF)

Personal Injury or Illness Forms

  1. FMLA Packet (PDF)
  1. Medical Return To Work Evaluation: Personal (PDF)
  1. Short Term Disability Claim Form: Standard (PDF)

Personnel Recommendation Forms

  1. New Hire/Rehire PR (PDF)
  1. Separation PR (PDF)
  1. Status Change PR rev 8.2017 (PDF)

Risk Management Forms

  1. First Report of Injury Form and Instructions (PDF)
  2. Medical Return to Work: Work-Related (PDF)
  1. Resident Incident Report (PDF)
  2. Risk Management Incident Report (PDF)
  1. Supervisors On The Job Incident and Injury Report (PDF)