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CLASSIFIED PERSONNEL HEALTH WELFARE ELECTION FORM NEVADA COUNTY RESIDENTS July 1 2016 through June 30 2017 EACH ELIGIBLE CLASSIFIED EMPLOYEE MUST COMPLETE FOR FISCAL YEAR 2016 2017 The following costs are based on the SIG rates for the 2016 2017 school year and the tiered district health welfare cap for the 2016 2017 school year. 75 22. 25 Do you elect Vision Insurance YES or NO Circle Vision Plan Composite Rate Employee and/or Family Example of Employee only choosing HNHDP with...
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How to fill out classifiedpersonnelhealthampwelfareelectionformnevadacountyresidents
01
Read the instructions carefully before starting to fill out the form.
02
Provide all the required personal information, such as full name, address, and contact details.
03
Enter your employment details, including your job title, department, and employee ID.
04
Choose the appropriate health and welfare benefits you wish to elect.
05
If there are any dependents, provide their information as well.
06
Carefully review the form to ensure all the information is accurate and complete.
07
Sign and date the form.
08
Submit the completed form to the relevant department or personnel office.
Who needs classifiedpersonnelhealthampwelfareelectionformnevadacountyresidents?
01
Employees classified under the personnel category in Nevada County.
02
Residents of Nevada County who qualify for health and welfare benefits as classified personnel.
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