FORMS & More!

by Jackie Wells, Business Manager

2022-2023 Insurance Rates _ Certified Staff
2022-2023 Insurance Rates _ Classified Staff

If you are currently enrolled in the district's WELLMARK Health Plan, but want to change plans, please complete 
        Wellmark Current Enrollment & Waiver

If you are not enrollment in the district's WELLMARK Health Plan, but wish to enroll, please complete
    Wellmark Health Insurance Application

If you have any changes to your personal information OR want to cancel a family member from coverage, please complete
    Wellmark Change Form

WELLMARK Benefit Summary of Benefits

Wellmark $1000 Deductible Summary of Benefits

Wellmark $2000 Deductible Summary of Benefits

Wellmark $5000 Deductible Summary of Benefits



Lincoln Financial At-A-Glance _ Life & ADD Insurance

Lincoln Financial Enrollment Form

LIFE Insurance Booklet

LTD Insurance Booklet

Avesis Vision Summary of Benefits

Avesis Vision Enrollment Form


Delta Dental At-A-Glance Booklet

Delta Dental Enrollment Form

Delta Dental Benefit Booklet

EMC On-Call Nurse - Work Related Injury

EMC ON-CALL Nurse

Master Contract 2019-2021
Master Contract 2021-2024

Employee Handbook - https://www.centrallyon.org/vimages/shared/vnews/stories/5ede4ea65b012/Employee%20Handbook%202020-21%20FINAL%2009-11-2020.pdf 

Family Medical Leave Act
FMLA Additional Information
Central Lyon Policy 409.3, pages 98-111 ~ https://www.centrallyon.org/vimages/shared/vnews/stories/4832dfb304db0/Series_400_3-2021.pdf
FMLA Certifications
    Maternity Leave
    Employee Serious Health Condition
    Family Serious Health Condition

Direct Deposit Authorization

IRS I-9 form

IRS W-9 form

Federal IRS W4 Form _ 2022

State of Iowa IRS W4 Form _ 2022