Employee benefits forms for active Los Rios employees.

Health Insurance Forms

Insurance Enrollment and Change Forms

Adjunct Insurance Forms

Vision Services Plan (VSP) Forms

Domestic Partner Forms

Insurance Waiver Forms 

Insurance Cancellation Request

For regular permanent employees:

Legal Insurance Forms


Health Savings Accounts (HSA)

Flexible Spending Accounts (FSA)

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)

Life Insurance Forms

Retirement Savings Plan Forms

403B Savings Plan

457 Savings Plans

Retirement Savings Distributions

Leave Forms

Five Month Law

Catastrophic Leave

Classified Staff

Certificated Staff

Family Medical Leave Act (FMLA)

Sick Leave and Vacation Forms