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New! Updated COVID Leave Form

The COVID leave form has been updated in May 2022.

Employee benefits forms for active Los Rios employees.

Absence Reports/Timesheets

Health Insurance Forms

Insurance Enrollment and Change Forms

Adjunct Insurance Forms

Long-Term Temporary (LTT) Insurance Forms

Domestic Partner Forms

Insurance Waiver Forms 

Insurance Cancellation Request

For regular permanent employees:


Health Savings Accounts (HSA)

Flexible Spending Accounts (FSA)

Life Insurance Forms

Long-Term Care Insurance Forms

Class 001 – Classified Staff Working at Least 20 Hours Per Week

Class 002 – Certificated Staff Working at Least 50%

Class 003 – Adjunct/Permanent Part-Time Staff (Not Qualified for Class 001 or 002)

Leave Forms

Catastrophic Leave

Classified Staff

Certificated Staff

COVID-19 Leave Certification

Five Month Law

Family Medical Leave Act (FMLA)

Sick Leave and Vacation Forms

New Hire Forms

Retirement Savings Plan Forms

403B Savings Plan

457 Savings Plans

Retirement Savings Distributions