Full-Time Employees

Below are forms for full-time park district employees.

- Full-Time Benefit Summary -

Insurance Forms

• Consumer Coverage Disclosure Act (CCDA)
• 2020-2022 Illinois Essential Health Benefit Listing
• PPO BCBS Application
• Blue Cross Blue Shield Explanation of Benefits
• Dental Explanation of Benefits
• Blue Access
• Find a Doctor
• COBRA General Notice
• Declination of Group Health Insurance
• Dental Enrollment Form
• Insurance Rate Sheet
• EyeMed Enrollment Form
• Flex Pay Election Form
• FMLA Employee Request Form
• FSA / HRA Reimbursement Form
• HIPAA Notice
• HMO Enrollment Form
• PPO Benefit Summary
• HMO Benefit Summary
• HRA with CrossTech Enrollment Kit
• Metlife Beneficiary Form
• FSA Change In Status Form
• Retirement Checklist

Employment Forms

• I-9 Employment Eligibility Verification Form
• W4 (2023)  IL State  |  Federal
• Affirmative Action Voluntary Information
• DCFS Acknowledgement

Illinois Municipal Retirement Fund

• IMRF Enrollment Form
• IMRF – New Employee FAQ