Documents & Forms
Employee Forms
Form Name
Fitness Reimbursement
Description
The City will reimburse an employee 50% of your monthly gym membership fee (max reimbursement $25 per month) with proof of membership and proof of 8 gym visits per month.
Link
Name, address, and phone number change
Fill out this form for changing name, address, and phone number.
(Note: documentation of name change will be required)
Vacation pay request
Noncontract employees may request up to 80 hours in vacation pay out each year, as long as they have 40 hours remaining.
2024 Dr. Visit Form
Employees and their spouses on our healthcare plan may receive a $50 gift card, each, if they go to their doctor for a wellness visit. Due by 11/30/24
LabCorp Form
Employees and their spouses on our healthcare plan may receive a $50 gift card each, if they complete biometric screening. This may be done at the doctor, when we offer it onsite, or at a LabCorp location. Due by 11/30/24
Claim Forms
Form Name
Description
Link
Medical Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Dental Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Vision Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Life Change Forms
Changes can only be completed outside of open enrollment when there is a qualifying life event. This includes marriage, divorce, birth or adoption, or spouse’s change in insurance. Notice of a qualifying life event is due within 30 days.
Form Name
Description
Link
Enrollment Change Form
This form must be downloaded, completed and returned because it entails personal information.
Spousal Coordination of Benefits Questionnaire
The City of Oxford requires spouses to join their employer’s health insurance as their primary insurance. Spouses may only be listed as primary on the City of Oxford insurance if they do not have access to insurance, or if they must pay 55% or more of the total premium cost.
This form documents a spouse’s access (or lack of) to insurance by their employer.
Equitable Life Insurance Change Form
This form must be downloaded, completed and returned because it entails personal information.
VSP Supplemental Vision
This form must be downloaded, completed and returned because it entails personal information.
HealthEquity Flexible Spending Form
This form must be downloaded, completed and returned because it entails personal information.
Workers' Compensation Forms
Form Name
Description
Link
Injury Reporting Packet
These forms are required BWC forms to be filled out by injured employee and the attending physician.
Personal Injury Report
This form is to be filled out by the employee and supervisor and sent to HR.
Witness Statement Form
This form is to be filled out by the witness(es) of the incident, if applicable.
C-55 Salary Continuation
Fill out this form if requested.
Employee Handbook
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Employee Handbook (revised in 2022)
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Classified Service Procedures and Personnel Appeals Board Rules and Regulations
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Union Contracts
The City of Oxford has three public employee unions.