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Kern County Human Resources
Declination of Coverage and Certificate of Other Coverage
As an eligible employee of Kern County I understand I have the option of accepting employee health benefits for
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How to fill out new hire declination of
How to fill out new hire declination of
01
Obtain the new hire declination of form from the human resources department.
02
Read the instructions on the form carefully.
03
Provide your personal information such as name, address, social security number, and contact details.
04
Fill out the sections regarding any previous employment history.
05
Review the sections regarding benefits and compensation, indicating any declines or decisions.
06
Sign and date the form at the designated areas.
07
Submit the completed new hire declination of form to the human resources department or designated personnel.
Who needs new hire declination of?
01
Any new employee who does not wish to participate in or decline certain benefits or compensation packages may be required to fill out a new hire declination of form. This can include individuals who already have alternative coverage, dependents covered under another plan, or those who wish to opt out of certain options provided by the employer. Employers may require all new hires to complete this form for record-keeping purposes.
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