Departments of Washington County

Human Resources

Director: Sherrie Larsen
Address: 197 East Tabernacle St.
St. George, UT 84770
Phone: (435)652-5878
E-mail: Sherrie.Larsen@washco.utah.gov

Policy Manual

Washington County Policy Manual

Human Resources Forms

UTAH RETIREMENT SYSTEMS:

• 401(k) & 457 Plan Enrollment Contract (for NEW enrollment)
• 40l(k) & 457 Investment Contract (to change deferral amts/transfer among investment options)
• Change in URS Records (address, name & marital status changes)
• Beneficiary Designation Form (All Plans)
• IRA Enrollment Contract (for NEW enrollment or to make beneficiary changes)
• IRA Investment Contract (to change deferral amts/transfer among investment options)

PEHP:

• Group Term Life Disclosure
• Group Term Life - Employee
• Group Term Life - Spouse/Dependent
• Group Term Life - Accidental Death
• Group Term Life Change Form - Beneficiary
• PEHP Address Change

OTHER INSURANCES:

• Educators Mutual Medical Insurance Enrollment Form (add/delete dependants / change address / new enrollment)
• MEDCO Home Delivery
• FLEX Spending Application Enrollment Form
• FLEX Spending Reimbursement Form
• VSP Vision Information Benefit Sheet
• Short Term Disability Information

PAYROLL/HR FORMS:

• Direct Deposit
• Emergency Information
• Employment Application
• I-9 Employment Eligibility Verification
• PTO Donation Form
• PTO Sell Back Form
• Tuition Reimbursement
• W4 2009
• 2009 Holidays
• 2009 Pay Periods
• 2010 Pay Periods

NOTE: If you change your address, you'll need to resubmit the highlighted forms to HR

Important Telephone Numbers

Educators Mutual
800-662-5851
www.educatorsmutual.com

Medco - Prescription
800-316-9176

VSP Vision
800-877-7195
www.vsp.com

(EAP) Employee Assistance Program
800-926-9619
www.blomquisthale.com

Apple Program
888-346-0990
www.appleprogram.com