Forms

Application - Employment Required for every new hire

Application - Volunteer 

Address Change Form(s)

• Allegiant Care
• HealthTrust 
• NH Retirement
• Town of Milford 

Background Checks

• Bureau of Elderly and Adult Services 
• CRC - EMS CHRI Request Form 5.1.17
• NH Criminal Record Check 
• NH Division of Motor Vehicle Check (Release of Motor Vehicle Record)
• Reduced Fee Request Form (pdf) (SECTION 5703.07 Fee Exemption of the Rules and Regulations for the Operation of the Central Repository: (d) Volunteers for public or private not-for-profit agencies that provide services to the elderly, the disabled or children shall be charged $10.00 for each criminal record check requested.)
• DMV - (pdf)

EAP (Employee Assistance Program) and LAP (Life Assistance Program) 

• Cigna LAP - Is available to all staff participating in the Life, STD and LTD programs.  Call 1-800-538-3543 
• HealthTrust EAP - Is available to employees, retirees, volunteers (and their household members).  Call our toll-free number 1-800.759.8122 or access Work/Life Online at AllOneHealthEAP.com username: healthtrust, password:  member

Emergency Contact Form To be completed by every new hire

Enrollment Form (jpg, pdf) HR to complete

Evaluation Forms

• Self Evaluation 
• Supervisor Evaluation
• Employee Evaluation

Exit Interview Form 

Flexible Spending Account - HealthTrust

• FSA Enrollment Form (pdf)
• FSA Enrollee Brochure (pdf)
• FSA Election Worksheet (pdf)
• FSA Healthcare List of Eligible Expenses 4.2020 (pdf)

Hampshire Hills

• Rate Information Sheet
  • Hampshire Hills Flyer 50 off
  • Quarterly Billing Change 2.1.2023 Memo
  • Employee Billing Change 2.1.2023 Memo
• Volunteer Affadavit revised 6.2020 (see "How do I" tab)
• Volunteers who volunteer 6+ hrs/month can sign up for the Hampshire Hills discount under the Town plan (does not apply to schools).
• Any employee 18 or over can sign up to receive this benefit.  Employees working 20+hrs/wk can have a paycheck withholding.  Employees working less than 20hrs/wk will be billed quarterly.
• The membership must be in the volunteer's name. 
• The volunteer must be 18 or over to receive this benefit - involves signing agreements.
• See "How do I" tab for addtional information on signing up for Hampshire Hills.

Hiring Checklists

• New Hire Checklist (HR) 
• New Hire Checklist (Department Heads) 
• New Hire Checklist (Youth) 

I-9 Employment Verification Eligibility To be completed within 3 days of hire

• I-9 2023 (expires 7.31.26)
• I-9 Instructions (Exp 7.31.26)

Job Description Template (doc) For Managers and Department Heads to use as a point of reference.

Job Requisition Form Must be completed before posting positions on website or ApplicantPro

Leave of Absence Form

NH Retirement Forms - (see Benefit Information tab) To be completed by all FT employees

• NHRS Enrollment Forms
• NHRS Designation of Beneficiary Form (pdf)
• NHRS w-9 Form (pdf)
• AFSCME only -- SSA 1945 Windfall Elimination Provision (WEP) (pdf)   
  • (WEP)  and Government Pension Offset 
  • SSA 1945 Acknowledgement
• Terminated Member's Application for Refund of Contributions (pdf)

Payroll Status Change Form (jpg, pdf) For new hire, rate change, address change, coming off probation, termination, etc.

Receipts (Acknowledgements) To be completed by all new hires

• Receipt of AFSCME Agreement (jpg) ) Police Officer/Detective/Master positions only
• Receipt of Employee at Will Statement (jpg)
• Receipt of Employee Handbook (jpg)
• Receipt of Harassment Policy (jpg)
• Receipt of Inclement Weather Policy (jpg)
• Receipt of JLMC Manual (jpg)
• Receipt of Teamster Agreement (pdf) Teamster positions only d/c 9/20/2023
• Receipt of Timeclock Policy (jpg)
• Receipt of Annual Notices 

Request for Leave of Absence (jpg not fillable, pdf fillable) For anyone going out on leave

Reference Check Form (pdf)

Second Injury Form (pdf) To be completed with Human Resources SIF Brochure - from Primex

Tuition Reimbursement  Eligible employees include full-time, non-union employees who have successfully completed their probationary period. EDUCATION REIMBURSEMENT POLICY (and forms)

Waivers

• 2023 Waiver Form for Health and Dental Insurance
• Waiver Lunch - NH DOL no longer using

Worker's Compensation  

To be completed in the event of a workplace accident. ALL forms should be returned to HR ASAP.

• Notice of Accidental Injury or Occupational Disease 8aWCA (DOL) - Employee Completes
• First Report of Injury (FROI) (DOL) - Employer/Dept Head/Sup/Mgr completes
• Exposed Worker Incident Report Form - Employer/Dept Head/Sup/Mgr completes

Town of Milford Specific

• Town Notice of Accidental Injury (Employer Information pre-loaded) - Employee Completes - Sent to Primex
• Town FROI (Employer information pre-loaded) - Employer/Dept Head/Sup/Mgr completes - Sent to Primex
• Accident Investigation Reports -  Internal document - To be completed by Department Head when notified of a Worker's Compensation incident.  This form is reviewed by the JLMC Accident Investigation Committee.
• NON Employee Accident Report - To be completed by whomever witnesses or is reporting the incident.
• Workplace Violence Incident Reporting Form

Direct Deposit - Start (jpg, pdf)

Notice to all employees 9/2019 - Direct Deposit Process 

Has to be completed to process direct deposit request (please attach a copy of a canceled check) 

Has to be completed upon hire and when any changes need to be made to withholding

About Form W-4

See "How Do I FAQ's..." Section for links to videos

IRS Withholding Calculator