Forms and Information

Employee Forms & Information

Leave Forms

  • Leave Request Form
  • Request to receive leave donations
  • Leave Donation (to another employee)
    • Leave donation (PDF version)

Family Medical Leave Policy & Forms

The information on this web page will help you navigate Family/Medical Leave as it is applied at the City and Borough of Juneau. Family/Medical Leave is administered in accordance with the federal Family Medical Leave Act, the National Defense Authorization Act for FY2008, the Alaska Family Leave Act, and CBJ Administrative Policy 13-01, Family/Medical Leave.

Whether you are an employee who may need to request leave or a manager or supervisor who has an employee with a Family/Medical Leave entitlement, the following information will provide you with information and guidance needed to administer Family/Medical Leave. If you have questions about specific applications or issues after you have reviewed the materials, please contact the Human Resources/Risk Managment Office.

  • What is Family/Medical Leave?
  • When Shoud Family/Medical Leave be Invoked?
  • Family/Medical Leave Definitions
  • Family Medical Leave Packet
    • Administrative Policy 13-01R, Family/Medical Leave
    • Your Rights and Obligations under Family/Medical Leave
    • FMLA – Authorization Letter (word format)
    • FMLA – Exigency Leave (word format)
    • Certifcation of Health Care Provider (word format)
    • Return to Work Certification (word format)
    • FMLA – Affidavait of Domestic Partnership (word format)
  • Other Resources
    • Family/Medical Leave Departmental Worksheet (word format) – print this form to use as a guide and checklist for the steps and forms need to administer Family/Medical Leave
    • 2017-2019 Family/Medical Leave Usage Tracking Form (excel format) – use this spreadsheet to track Family/Medical Leave use
    • Frequently Asked Questions and Answers
    • U.S. Department of Labor Website – this link will take you directly to Department of Labor information

Health Benefits / Life insurance Forms

Safety Program Forms

New Employee Forms

  • New Employee Packet ◦Checklist
    • I-9
    • W-4
    • EEO
    • Post Hire Questionnaire
    • Direct Deposit Form
    • Report of Outside Employment Form
    • Minor Work Permit
  • Additional Employment Information
    • Administrative Policies/Conflict of Interest
    • Impact of License Revocation
    • Pay Schedule
    • CBJ Phone Directory
    • 2017 Holiday Schedule
  • HRRM News & Information Page
  • Bargaining Agreements and Websites
  • CBJ Policies and Procedures
  • Employee Assistance Program
  • Employee Benefits

Job Classifications

  • JobTitles/Pay Ranges
    • All CBJ, Listed By Class Code

Pay Information

  • Pay Dates
  • Salary Schedules
  • Payroll Forms
  • Pay Calculator

Employee Self Service Instructions

  • ESS & Time Entry (Hourly)
  • ESS & Time Entry (Salary)

Pay-Related Forms & Information

  • Payroll Withholding, W4 Form and Instructions
  • Direct Deposit Enrollment Form
  • Application for New or Replacement Social Security Card
  • Mileage Reimbursement – See CBJ Personnel Rule 18 PR 045
    • Reimbursement Form
  • Deferred Comp Change Form
  • Personal Leave Cash-In Request.

Employee Self Service Instructions

  • ESS & Time Entry (Hourly)
  • ESS & Time Entry (Salary)

Manager Self Service Instructions

  • Time Card Approval
  • Pay Day & Time Sheet Schedules
    • 2016 Employee Pay Schedule
    • 2016 Admin Pay Schedule with black-out dates
    • 2017 Employee Pay Schedule
  • Time Sheet Sample Form
    • Hourly & Salary Pay Tables
      • MEBA Employees
        • 2012
        • 2013
        • 2014
        • 2015
        • 2016
      • Unrepresented Employees
        • 2012
        • 2013
        • 2014
        • 2015
        • 2016
      • PSEA Employees
        • Fiscal Year 2017
      • IAFF Employees
        • 40Hour/Week
          • 2013
          • 2014
          • 2015
        • 56Hour/Week
          • 2013
          • 2014
          • 2015
      • Eaglecrest Employees ◾FY15

Payroll Calculator
•Job Classification
◾Job Class Titles/Pay Ranges

Risk Management Forms & Information

Safety-Related Forms

  • Site Review Form
  • Safety Meeting/Training Form

Accident/Injury Forms

  • Print Copy Accident Injury Report Revised 2016
  • Fillable Accident Injury Report Revised 2016
  • Print Copy Property Damage Report Revised 2016
  • Fillable Property Damage Report Revised 2016
  • Instructions for completing the Report of Occupational Injury Form
  • 07-6100 Employee Report of Occupational Injury Form
  • 07-6101 Employer Report of Occupational Injury Form

Updated 4/1/16

Health Insurance

  • Medical, Dental, Vision Claim forms
  •  Prescription Claim forms
  • Affidavit of Marriage
  • Air Travel Benefit Advisory
  • Student Verification
  • Enrollment/Change form

Life Insurance

  • Voluntary Life-ADD enrollment
  • Change of Beneficiary form
  • Fiscal Year 2015 Risk Management Report
  • Notice of Claim Form

More contents will be added to this site later. To request the addition of human resource or risk management forms or information, contact Anna Percival in the Human Resources & Risk Management Department at 586-5250 or Anna.Percival@juneau.org