| Officer of the Day Accrual and Leave Use Form |
This form and instructions are for managers (not eligible for overtime) to use when they are assigned "officer of the day" duty. It is attached to DOC policy 40.2.2. Officer of the day leave cannot be processed unless this form is attached to the timesheet for the month they serve the duty. Duty duration for officer of the day assignments consist of seven (7) 24 hour periods. The manager serving the duty will receive 8 hours of leave (OD) for each 7 days of duty (ODA).
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W-4 Form
Employee Withholding Allowance Certificate (pdf) |
This is the IRS W-4 form. Employees use this form to make changes to their payroll tax exemptions. If you want different amounts deducted for your federal and state income taxes, fill out a separate form for each and note at the top "FEDERAL" or "STATE". For additional information, contact your personal tax advisor. Once filled out, please send this form to your agency payroll contact as soon as possible. |
W-5 Form
Employee Earned Income Credit Form (pdf) |
This is the IRS W-5 form. Read the instructions to make sure you qualify for the Earned Income Credit (EIC). For additional information, contact your personal tax advisor. Once filled out, please send this form to your agency payroll contact as soon as possible. |
Payroll Advance Form (pdf)
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This is the State of Oregon Payroll Advance form. Eligible employees may qualify for an emergency payroll advance of 60% of wages earned to date, less any court-mandated deductions. Once filled out, give this form to your supervisor for approval. Your supervisor will send this form to your agency payroll contact for final approval and to process the payroll advance request. There is a 24-48 hour turnaround to receive the payroll advance if approved. |
Payroll Direct Deposit Form (pdf)
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This is the State of Oregon Payroll Direct Deposit form. Employees may have up to 4 fixed deposits (specific dollar amounts) and 1 net deposit (balance of your net check). Virtually all banks and credit unions participate in Direct Deposit. Check with your co-workers... you´ll find that 72% of State of Oregon employees participate in Direct Deposit. Once filled out, please send this form to your agency payroll contact as soon as possible. |
Social Security Card
Request Form |
This is the Social Security Card Request form. Use this form to apply for a social security card, or to request a copy of your social security card. This form must be taken in to your local Social Security Office with the necessary documentation to complete your request. |
| Employee Emergency Information Form (pdf) |
This is the Employee Emergency Information form. Use this form to change your emergency contact information. Once filled out, please send this form to your agency Personnel Records contact as soon as possible. |
Understanding Your State of Oregon Paycheck (doc)
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This information will help you better understand your State of Oregon Paycheck or Direct Deposit Stub. |
PEBB
Medical/Dental Update Form (pdf) |
This is the PEBB Medical/Dental Update form. This form is used during the plan year to make changes to your medical and dental benefits due to a qualified family status change. A qualified family status may include marriage, divorce, birth, death, and changes in your work status or the work status of your spouse/domestic partner. You have 31 days from the date of the qualifying family status change event to complete this form. Once filled out, please send this form to your agency payroll contact as soon as possible. |
PEBB
Life Insurance Update Form |
This is the PEBB Life Insurance Update form. This form is used during the plan year to make changes to your employee life insurance, spouse/domestic partner life insurance, disability insurance, and dependent life insurance due to a qualified family status change. A qualified family status change may include marriage, divorce, birth, death, and changes in your work status or the work status of your spouse/domestic partner. You have 31 days from the date of the qualifying family status change event to complete this form. Once filled out, please send this form to your agency payroll contact as soon as possible. |
PEBB Domestic Partnership Affidavit Form (pdf)
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This is the PEBB Domestic Partner Affidavit form which must be filled out to enroll an employee´s domestic partner for insurance benefits. Once filled out, please send this form to your agency payroll contact as soon as possible. |
PEBB
Domestic Partnership
Termination Form (pdf) |
This is the PEBB Domestic Partner Termination form which must be filled out to end a domestic partnership for insurance benefits. Once filled out, please send this form to your agency payroll contact as soon as possible. |
| IAP: Pre-Retirment Designation (pdf) |
This is the IAP-PERS Beneficiary form. This form is used by all IAP-eligible employees to provide beneficiary information to PERS. |
PERS Beneficiary Form (pdf)
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This is the PERS Beneficiary form. This form is used by PERS-eligible employees to provide beneficiary information to PERS. This is a two-sided form... one side is the "standard" beneficiary statement, and the other side allows the employee to specifically designate who their beneficiary is. PLEASE NOTE: fill out one side of the form only. Once filled out, please send this form to your agency payroll contact as soon as possible. |
PERS Update Form (pdf)
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This is the PERS Update form. This form is used by PERS-eligible employees to change their name, mailing address, or other information. Once filled out, please send this form to your agency payroll contact as soon as possible. |
PERS
Police & Fire
(P & F) Units Form (pdf) |
This is the PERS P & F Units form. This form is used by PERS-eligible employees in a "police & fire" classification to purchase additional units towards their retirement. Page 2 shows the amounts to be deducted by age at time of approval, based on the maximum "8 units". For additional information on PERS Retirement go here. Once filled out, please send this form to your agency payroll contact as soon as possible. |
Fortis
Life Insurance
Update Form (pdf) |
This is the Fortis Life Insurance Update form. This form is used by employees in a "police & fire" classification to make changes to their Fortis Insurance coverages. Once filled out, please send this form to your agency payroll contact as soon as possible. |
Standard Insurance
Short Term Disability Policy |
This is the Standard Insurance Company Short Term Disability policy, which can answer questions regarding your short term disability insurance. |
Standard Insurance
Long Term Disability Policy |
This is the Standard Insurance Company Long Term Disability policy, which can answer questions regarding your long term disability insurance. |
Standard Insurance
Group Life Insurance Policy |
This is the Standard Insurance Company Group Life Insurance policy, which can answer questions regarding your optional employee, spouse, domestic partner, and/or dependent life insurance. |
Standard Insurance
Accidental Death and Dismemberment Policy |
This is the Standard Insurance Company Accidental Death and Dismemberment policy, which can answer questions regarding your accidental death and dismemberment insurance. |
| Fortis Life Insurance Policy (pdf) |
This is the Fortis Life Insurance policy, which can answer questions regarding your Fortis life insurance. |
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Additional Links
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