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ACTIVE EMPLOYEE TOBACCO AFFIDAVIT The City of Miami Beach (“the City “) wants employees to live healthier lives. To avoid a tobacco surcharge, complete this affidavit and return it to the HR DEPARTMENT

How to fill out active employee tobacco affidavit

How to fill out active employee tobacco affidavit

1. To fill out the active employee tobacco affidavit, follow these steps:
2. Obtain the active employee tobacco affidavit form from your employer or HR department.
3. Read the form carefully and make sure you understand all the instructions and requirements.
4. Fill out your personal information, such as your name, address, and contact details, in the designated fields.
5. Provide accurate and truthful information about your tobacco use, including the frequency and duration of use.
6. Sign and date the affidavit to certify that the information provided is correct to the best of your knowledge.
7. Submit the completed form to your employer or HR department as instructed.
8. Keep a copy of the filled-out affidavit for your records.

Who needs active employee tobacco affidavit?

1. Active employee tobacco affidavit is required for employees who use tobacco products and need to disclose their tobacco use to their employer or HR department.
2. This affidavit may be necessary for various purposes, such as determining eligibility for certain benefits, insurance coverage, or participation in wellness programs.

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