Human Resources Forms & Documents

Personnel Policy Manual Forms

FORM # DESCRIPTION UPDATED
1 Employer Acknowledgment of Adoption of Manual Original
2 Employee Acknowledgment Original
3 Application for Employment Original
4 SEE HR Original
5 SEE HR Original
6 Performance Improvement Plan Original
7 Request for Leave Original
8 Request for Leave of Absence Without Pay Original
9 SEE FMLA TAB Original
10 Complaint Form Original
11 EEO Anti-Discrimination Complaint Form Original
12 Notice of Pre-Disciplinary Conference Original
13 Counseling Session Form Original
14 Record of Discipline Original
15 Order of Removal, Reduction, Suspension, Fine, Involuntary Disability Suspension Original
16 Exit Interview Form Original
17 SEE FMLA TAB Original
18 Mileage / Parking Expense Report Original
19 Payroll Change Notice Form Original
20 Personnel File Release Original
21 Notification of Intent to Convert Sick Leave Upon Retirement Original
22 Authorization to Work Non-Scheduled Hours Original
23 Cell Phone Access and Usage - Departmental Authorization for Commissioners-Owned Cell Phone Original
24 Cell Phone Access and Usage - Inventory Receipt Original
25 Observed Behavior - Reasonable Cause Record Original
26 Occupational Illness or Injury Report Form Original
27 SEE ACCOUNTING Original
28 Travel Expense Report Original
29 Secondary Employment Original
30 NonCriminal Justice Applicant Privacy Rights Original

GENERAL BENEFIT INFORMATION

2021 Benefits Guide

HEALTH INSURANCE

Spousal Carve-Out Form

2021 Summary of Benefits & Coverage (PPO UMR)

2021 Summary of Benefits & Coverage (HDHP/HSA UMR)

LIFE INSURANCE

Life Insurance Claim Form

FMLA Forms

        UPDATED
Certification of Employee's Serious Health Condition Original
Certification of Family Member's Serious Health Condition Original
Certification of Qualifying Exigency for Military Family Leave Original
Certification for Serious Injury or Illness of a Current Servicemember Original
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave Original
General Medical Release Original
Request for Leave for a Covid-Related Illness Original

Workers Compensation Forms

        UPDATED
First Report of Injury Original
Employee Incident Report Original
Consent to Release Medical Information Original
Miami County Workers Compensation Process Document Original

Other Human Resources Forms

      UPDATED
Employee Information Change Form Original
Employee Requisition Form 05/19/2022

Human Resources

Hours of Operation
Monday-Friday, 7:30 AM - 4:00 PM

Other times by appointment

Address
Courthouse, First Floor
215 W. Main St., Troy, OH 45373

Email Human Resources

Human Resources Staff

Angela Lewis, Director

Season Hurley, Administrator
(937) 440-5917

Autumn McCuistion, Generalist
(937) 332-7090

Skylar Unger, Assistant
(937) 440-8045

Employment Verifications
(937) 440-5937

Employee Assistance Program

ComPsych Guidance Resources
Organization ID: EAPCEB
Company Name: MIAMI