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HR Forms Cabinet
Pre-employment Forms
Active Employee - Benefits Forms
Active Employee - Disability and Leaves Forms
Active Employee - Licensure Forms and Publications
Active Employee - Other Forms
- Direct Deposit Authorization Agreement (FS73-12)
- Discrimination or Harassment Complaint form
- Electronic Pay Advice Election Agreement (FS73-11)
- Name and Address Change (access through Uconnect)
- Notice of Intent to Exercise Recall Rights (fillable)
- Notification of Resignation/Retirement (HR-2)(fillable)
- Request for Accommodation (ADA) form
- Request Reissue of W-2 (FS73-66)(fillable)
- Request to Transfer Unused Sick Leave from FCPS (FS73-06)(fillable)
- Request to Transfer Unused Sick Leave to FCPS (FS73-07)(fillable)
- Tuition Reimbursement (VPN Required)
- Employee Assistance (EAP) Request form
- Interpreter Service Feedback form
Retiree Forms
- FCPS - Retiree Medical Enrollment & Change Form
- FCPS - Dental Enrollment & Change Form for Employees and Retirees
- County Life Insurance - Enrollment and Beneficiary Designation (FCERS members)
- Minnesota Life Insurance - Enrollment and Beneficiary Designation (VRS members)
- FCERS - Retirement Form
- ERFC - Retirement Form
- VRS - Retirement Form
- CNA Long-Term Care - Application Instructions for Retirees
- CNA Long Form - for retirees and spouses of retirees, parents and grandparents who wish to enroll
Tax Forms
All tax forms should be sent to:
Office of Payroll Management
Gatehouse Administration Center I,
8115 Gatehouse Road, Falls Chuch, VA 22042
- DC Employee Income Tax Withholding D-4
- Federal Employee Withholding Allowance W-4
- Maryland Employee Income Tax Withholding MW-507
- Request Reissue of W-2 (FS 73-66)
- VA Employee Income Tax Withholding VA-4
- West Virginia Income Tax Withholding WV/IT-104
- DC Certificate of Nonresidence D-4A
Student and Parent Forms
Educational Leadrship Internships
Student Teacher & Intern Information