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Staff Files

Please use these documents as needed. Please do not alter these documents in any way.

If you need to complete a form, save it to your computer first and then type in your information (browsers may not manage fillable forms correctly).

If you experience difficulty or would like to report a problem with this page please contact the Administrative Assistant at 503.233.6090.

For general HR questions please contact hrsupport@janusyouth.org

For assistance or questions regarding benefits, leave of absences, etc., please contact employeebenefits@janusyouth.org

General Employee Information/Forms

New Hire/Rehire PAF

Important Numbers for Employees

Employee Guidebook
TB/Hepatitis B Vaccine Resource
Referral Bonus Request Form
Internal grievance Form

Public Service Loan Forgiveness Information

PSLF Flyer
PSLF Information
PSLF Certification Form

Work Related Injuries

Employee Injury Report
801 SAIF Workers Comp Report for Oregon
Employees in WA file W/C report with the medical provider
W/C Packet Cover Page for Employees

Recognition

High Five Form – Peer to Peer

Recruitment

Reference Authorization and Release Form
Reference Check form – phone verification
Reference Check Form – email template

Evaluations

3 Month Evaluation Form
Sub-Worker Monthly Feedback Form

Health Benefits

Benefits Overview 2023
Benefit Chart 2023
Rate sheet for Medical, vision, and Dental
Kaiser Application
Addendum to Employee Enrollment and Change form
Willamette Dental Enrollment Application
MODA Dental Enrollment Form
Declination of Benefit Form
Discontinue Enrollment Form
Premium Only Plan
Kaiser Enrollment Brochure
Kaiser HMO Summary
Kaiser HDHP with HSA Summary
Kaiser Added Choice Summary
Willamette Dental Summary
WD HIPAA Notice
Amendment rates
MODA Summary

Life, Disability, EAP and Other Voluntary Benefits

Colonial Life Voluntary

Flexible Spending Account Enrollment Form
Flexible Spending Account Reimbursement Form
Transportation Enrollment Form
Transportation Reimbursement Change in Enrollment Form
Group Life and Accidental Death/Dismemberment Insurance Beneficiary Form
Voluntary Term Life Insurance Enrollment Form and Coverage Highlights
Employee Assistance Program
Employee Assistance – Travel Assistance Program

Retirement

Default Statement
401K Summary of Plan
401(k) Slim Guide
Employee Contribution Form

PTO/Protected Leave

Oregon Sick Leave Policy
Family and Medical Leave Policy
OR Paid Leave Brochure
Washington Paid Leave Brochure
Long Term or FMLA/State Leave Request Form
Donation Form-PTO Bank
PTO-Vacation Donation Policy
PTO Request for Donated PTO from Leave Bank

Safety Suggestion Box