This page houses various forms and information summaries that your may need throughout your time at the City of Richardson. Select a topic to view an alphabetical list of applicable documents.
Civil Service Rules & Regulations
Employee Information & Address Changes
Family Medical Leave Act (FMLA)
Interdepartmental Policies & Procedures
Medical & Dental Forms
Supervisor Resources & Information
- Catastrophic Leave
- Employee Information & Address Changes
- Accepted I-9 Documents - Document that lists documents accepted to verify an applicant's identity & ability to work in the United States.
- Change of Address Form (TMRS) - Complete and return to Human Resources to update your address to TMRS and all personnel records.
- General Information Change Form - Complete and return to Human Resources to update phone numbers, marital status, and/or emergency contact information.
- Life Insurance Beneficiary Change Form - Use this form to designate or update beneficiaries for all life insurance products.
- FMLA (Family Medical Leave Act)
- Certification of Health Care Provider (Employee) - Provide form to medical provider for employee's condition.
- Certification of Health Care Provider (Family Member) - Provide form to medical provider for family member's condition.
- Certification of Qualifying Exigency Leave for Military Family Leave - Use to certify exigency leave arising from a family member being called to active duty.
- Certification of Serious Injury/Illness of Servicemember: Use to certify leave to care for an injured or ill active servicemember.
- Certification of Serious Injury/Illness of Veteran: Use to certify leave to care for an injured or ill veteran.
- Designation Notice - Use to designate leave as protected under FMLA.
- Medical & Dental Forms
- BCBS Medical Claim Form - Use to submit claim for Medical Services.
- BCBS Dental Claim Form - Use to submit claim for Dental Services.
- CORPlan Insurance Add/Delete Form - Use to add or delete yourself or dependents due to a change in family status.
- HIPAA Authorization Form - Use to authorize disclosure of Protected Health Information.
- Health Savings Account (HSA) Enrollment Form - Employees enrolled in the Green (HDHP) plan use to enroll or make changes to a current HSA election.
- Spouse's Insurance Coverage Affidavit - Employees on CORPlan electing to insure their spouse must complete this form.
- City Approved Holidays - List of approved holidays for the upcoming year.
- Certification of Business Miles Driven Form - Employees assigned a car allowance can use form to reduce taxable income due to business miles drive.
- Employee Extended Absence: Initial Report - Employee can use this form after being out for a minimum of 1 month due to illness or injury.
- Employee Extended Absence: Supplemental Report - Employee can use as needed to check in following the initial report of employee extended absence.
- Notary Application Instructions - Instructions to complete a Notary application.
- Pre-Travel & Travel Advance Authorization Form - Must be completed prior to all travel; submit to supervisors, etc for required approvals. Post Travel Expense Form to be completed upon return with original receipts.
- Tuition Reimbursement Application Form - Use to apply for tuition reimbursement.
- Vehicle Liability Insurance Card - Employee renting vehicle for city business use card to verify insurance.
- Prescription / Pharmacy
- Express Scripts Maintenance Medication List - A list of maintenance medications as indicated by Express Scripts.
- Free Glucose Meter Information - Instructions to order your preferred blood glucose monitoring system.
- Prescription Mail Order Form - This form is for Express Scripts ONLY. There is no mail order form for Walgreens.
- Deferred Compensation Acknowledgement of Maximum Contribution - Retiring & Terminating employees use form to allocate their final pay out of sick/vacation to their deferred compensation account.
- Retiree Insurance Election Form - Employees use form to complete insurance elections for retirement.
- Supervisor Resources & Information
- Applicant Evaluation Form - Use to aid the supervisor/manager during the hiring process.
- Attendance Calendar - Use to notate absences (excused/unexcused) for the calendar year. (2019 Attendance Calendar is here.)
- Filling Vacant Positions Guidelines - Describes the process used to fill vacant positions.
- Interview Guidelines - Offers support regarding interview questions.
- Nepotism Relationships - Chart defining degrees of blood and marriage relationships.
- New Employee Orientation Checklist - Use ensure all aspects of orientation are addressed with the new employee.
- New Employee Orientation Guide - Use to plan first day/week of a new employee.
- New Hire Salary Approval Form - Before an job offer is made to a full-time or part-time employee, this form must be completed if the salary offer will be above the minimum of the salary range. Review the New Hire Salary Approval Form instructions if you have additional questions.
- Wellness Program
- Annual Physical Exam Form - Use to verify a preventative, physical exam completed by a Doctor. The Doctor should complete the form and fax it to LiveBright by September 30, 2018.
- Biometric Screening & Physical Exam Form - Use to verify a preventative, physical exam and biometric screening completed by a Doctor. The Doctor should complete the form and fax it to LiveBright by September 30, 2018.
- Wellness Activity or Screening Validation Form - Use to verify the completion of a non-city sponsored Wellness Activity or Preventative Screening.
- Wellness Champion Application - Additional information and application to become a department Wellness Champion. Earn 15 points towards your 100 point goal, if you are selected.
- Wellness Event Calendar - Schedule containing information regarding the time and location on Wellness Events for the remainder of the Wellness Program year.
- Worker's Compensation
- Employer's Report of Injury/Illness - Required form to be completed by the supervisor/manager following the employee's notification of work related injury.
- Physical Capabilities Form (8 Hours) - Completed by a physician to indicate physical limitations/restrictions of an injured or recovering employee working an 8 hour shift.
- Physical Capabilities Form (10 Hours) - Completed by a physician to indicate physical limitations/restrictions of an injured or recovering employee working an 10 hour shift.
- Supplemental Report of Injury - Use to report all post-injury and return to work changes of earnings.
- Temporary Prescription Card - Use to cover medications in only Worker's Compensation injury cases.