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Employee benefits forms for active Los Rios employees.

Absence Reports/Timesheets

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:


Health Savings Accounts (HSA)

Flexible Spending Accounts (FSA)

Legal Insurance Forms

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

Retirement Savings Plan Forms

403B Savings Plan

457 Savings Plans

Retirement Savings Distributions