89 Hayden Rowe Street | Hopkinton | MA 01748 | Phone: 508-417-9360 | Fax: 508-497-9833

Human Resources

Commonly used employee forms appear below for your convenience. Many are screen-fillable. Please click on the form number to access the form. Please be aware that not all forms are applicable to all employees.

Please scroll down to view the complete list. If you have any questions, contact the Director of Human Resources for assistance.

LEAVE FORMS
 

 DOL-WH380E  FMLA Health Care Provider Form-Employee's Own Health Condition
 DOL-WH380F  FMLA Health Care Provider Form-Family Member's Health Condition
 DOL-WH384  FMLA Military Leave-Qualifying Exigency
 DOL-WH385 FMLA  Military Leave-Covered Service Member's Health Condition
 HPS-L1  Request for Leave or Approved Absence
 HPS-L2  Advanced Leave Agreement
 HPS-L3  FMLA Employee Form (Non-HTA)
 HPS-L4  FMLA Employee Form (HTA)

BENEFIT FORMS -  Miscellaneous
 

 DHCFR-EHIRD  MA Health Insurance Responsibility Disclosure (HIRD)
 HPS-B1  Section 125 Cafeteria Plan Employee Waiver/Election & Compensation Reduction Agreement
 HPS-B3  Employee Assistance Program (EAP) Information
 TOH-B1  Town of Hopkinton HIPAA Privacy Notice
 TOH-B2  Town of Hopkinton HIPAA Privacy Acknowledgement

BENEFIT FORMS -  Flexible Spending Accounts

 HRC-1  Flex Spending Enrollment Form 13-14
 HRC-2  Flexible Spending Instructions
 HRC-3  Flexible Spending General Information
 HRC-4  Flexible Spending Worksheet
 HRC-5  Flexible Spending Claim Form

BENEFIT FORMS -  Health Insurance (Medical)

 TFT-1  Tufts Enrollment/Change Form (use for all Tufts products)
 TFT-2  Tufts HMO Premium Summary of Benefits
 TFT-3  Tufts Advantage HMO Summary of Benefits
 TFT-4  Tufts Carelink PPO Summary of Benefits
 TFT-5  Tufts Health Care Fitness Reimbursement Form
 TFT-6  Tufts Pharmacy Review Request Form
BENEFIT FORMS -  Health Insurance (Dental)

 ASRT-1  Assurant Dental Summary & Enrollment FY 12
 DEL-1  Delta Dental Enrollment/Change Form
 DEL-2  Delta Dental Premiere Voluntary Plan Information
 DEL-3  Delta Dental Incented Voluntary Plan Information
 DEL-4  Delta Dental Premiere Voluntary Enhanced Plan Information

BENEFIT FORMS -  Long-Term Disability Insurance

 SL-1  Sun Life Long-Term Disability Enrollment Form
 SL-2  Sun Life Long-Term Disability Claim Form
 SL-3  Sun Life Long-Term Disability Evidence of Insurability Form
BENEFIT FORMS -  Life Insurance

 BOS-1  Boston Mutual Life Evidence of Insurability Form
 BOS-2  Boston Mutual Authorization for Release
 BOS-3  Boston Mutual Life Enrollment/Declination Form
 BOS-A  Boston Mutual Voluntary Life Information
RETIREMENT PLAN FORMS

 CPI-0  403(b) Information Sheet
 CPI-1  403(b) Elective Deferral & Vendor Election Form
 CPI-2  Approved 403b Plan Vendor List
 CPI-3  CPI Participant Website Instructions-403(b)
 CPI-4  Request for a Contract Exchange-403(b)
 CPI-5  Request for a Loan Voucher-403(b)
 CPI-6  Request for a Hardship Withdrawl Voucher-403(b)
 CPI-7  Request for a Distribution-403(b)
 MCR-1  Middlesex County Retirement Board Enrollment Form
 OBRA-1  OBRA (Mandatory Deferred Comp Plan) Information Sheet
 OBRA-2  OBRA Acknowledgement Card
 OBRA-3  OBRA Smart Plan Information Guide
 TOH-B3  Town of Hopkinton Retiree Exit Form (to elect retiree health benefits)
PROFESSIONAL DEVELOPMENT FORMS

 HP-PD Instructions  Coursework Procedures Information Sheet
 HPS-PD1  Request for Conference Attendance
 HPS-PD2  Intent to Submit
 HPS-PD3  Course Approval
 HPS-PD4  Tuition Reimbursement and/or Course Credit Request
 HPS-PD5  Summer Curriculum Project Proposal
 HPS-PD6  Inservice Course Credit Award Program Guidelines
 HPS-PD7  Inservice Course Credit Approval
 HPS-PD8  Inservice Course Certificate of Successful Completion
PERFORMANCE EVALUATION TEMPLATES

 HPS-EVALSS/AA  Evaluation Form - Secretarial Support/Administrative Assistants
 HPS-EVALTA/GenEd  Evaluation Form - General Education Teaching Assistants
 HPS-EVALTA/SpEd  Evaluation Form - Special Education Teaching Assistants
RECRUITING FORMS FOR ADMINISTRATORS

 HPS-CR  Candidate Interview Rating Sheet-Numerical Score Format
 HPS-CR1-LIK  Candidate Interview Rating Sheet-Likert Scale Format
 HPS-R1  Request for Approval to Begin Hire
 HPS-R2  Highly Qualified Teacher Checklist
 HPS-R3  Highly Qualified Teacher Status Certificate
 HPS-R4  Recommendation to Hire
 HPS-R5  Release & Waiver of Confidentiality
 HPS-R6  Interview Confidentiality Statement
 HPS-REF1  Reference Check
MISCELLANEOUS NEW HIRE FORMS

 FED-I9Y  Employment Eligibility Verification (I-9)
 HPS-NH1  District Property Inventory
 MA-EP  Employment Permit Application for 14 through 17 year-olds
 SSA-0510007  Government Pension Offset Fact Sheet
 SSA-0510045  Windfall Elimination Provision Fact Sheet
 SSA-0510051  How State & Local Government Employees Are Covered by Social Security & Medicare
 SSA-1945  Statement Concerning Your Employment in a Job Not Covered by Social Security
PAYROLL FORMS

 FED-W4  Employee's Withholding Allowance Certificate (Federal W-4)
 HPS-CURR  Time Sheet for Curriculum Work Submission
 HPS-P1  Direct Deposit Request
 HPS-TA1  Non-Exempt & Contingent Employee's Time Sheet
 MA-M4  MA Employee's Withholding Exemption Certificate (MA M-4)
MISCELLANEOUS FORMS

 HPS-EH  Employee Handbook 2012-2013
 HPS-EHA  Employee Handbook Acknowledgement Form-Understanding by Employee
 HPS-EIR  Employee Personal Injury Report
 HPS-EX1  Mileage & Expenses Reimbursement Request (non-HTA)
 HPS-GBEBC  Employee Disclosure of Gifts
 HPS-IR  Incident Report
 HPS-M1  Employee's Request for Reasonable Accommodation
 HPS-SIA  Student Injury/Accident Report
 MA-ETH  Summary of the Conflict of Interest Law for Municipal Employees
 TOH-M1  Town of Hopkinton Hold Harmless for Volunteers
SUBSTITUTE PACKET FOR ADMINISTRATORS

 FED-I9Y  Employment Eligibility Verification (I-9)
 FED-W4  Employee's Withholding Allowance Certificate (Federal W-4)
 HANDBK  Substitute Handbook
 HDBK-ACK  Understanding by Substitute (Handbook Acknowledgement)
 MA-ETH  Summary of the Conflict of Interest Law for Municipal Employees
 MA-M4  MA Employee's Withholding Exemption Certificate (MA M-4)
 OBRA-1  OBRA (Mandatory Deferred Comp Plan) Information Sheet
 OBRA-2  OBRA Acknowledgement Card
 OBRA-3  OBRA Smart Plan Information Guide
 SSA-1945  Statement Concerning Your Employment in a Job Not Covered by Social Security
 SUB PAY  Substitute Pay Rate Information
 SUB-1  Substitute Teacher/Nurse Packet Instructions
 SUB-2  Substitute Teacher Application
 SUB-3  Substitute Interview Rating Form
 SUB-3  Substitute Teacher Job Description
 SUBN-2  Substitute Nurse Application
VOLUNTEER PACKET (for those volunteering in the schools)

 CON-INT  Summary of Conflict of Interest Law
 CORI-SUB  CORI Application for Volunteers
 HOLD-HARMLESS  Hold Harmless for Volunteers