Employee Forms

  1. BENX Health Reimbursement Account (HRA) CLAIM FORM (PDF)
  2. Direct Deposit Form (PDF)
  3. Family Medical Leave Act Certification of Health Care - Employee (PDF)
  4. Family Medical Leave Act Certification of Health Care - Family Member (PDF)
  5. Federal W-4 Form (2021) (PDF)
  6. Idaho State Tax W-4 Form - (PDF)
  7. III-A EMPLOYEE CHANGE FORM (PDF)
  8. III-A EMPLOYEE INTERNAL CLAIM FORM (PDF)
  9. III-A ONE AMERICA BENEFICIARY DESIGNATION (PDF)
  10. Persi Choice 401K (PDF)
  11. Vision & Life Insurance Enrollment Form (PDF)

Wellness forms

  1. PHYSICIAN AFFIDAVIT 2024.pdf