202 N. State Route 89
PO Box 406
Chino Valley, AZ 86323
(928) 636-2646
fax (928) 636-2144
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 HUMAN RESOURCES

EMPLOYEE DOCUMENTS, FORMS, AND INFORMATION


BENEFITS SUMMARY FY12/13

Administrative Calendar
  • Administrative Calendar for FY 12/13

    AFLAC
  • AFLAC Cancellation Notice

    Emergency Notification
  • Emergency Notification Form

    Health Insurance
  • 2012– 2013 Enrollment Guide
  • 2012– 2013 Benefits Elections Form
  • Well Call Flyer
  • Health Insurance Portability and Accountability Act (HIPAA) Notification
  • Medicaid and the Children’s Health Insurance Program (CHIP)

    ICMA
  • 547 Loan Refinance/Application Form

    Flexible Spending
  • Flexible Spending Account Packet - information has not change from FY11/12
  • Flexible Spending Account Form

    Life Insurance
  • Standard Life Insurance Enrollment/Change Form
  • Voluntary Life Insurance Worksheet

    Payroll Forms
  • Time Card
  • Leave Request
  • Overtime-Compensation Time Authorization Form
  • Payroll Direct Deposit Authorization Form
  • Employee's Arizona Withholding Percentage Election (A-4)
  • Federal Tax Form (W-4)
    •

    Tiffany Resendez
    HR Analyst
    (928) 636-2646 ext 1214
    Town of Chino Valley
    Human Resources Department
    202 N State Route 89
    Chino Valley, AZ 86323
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    "Looking To The Future"