Commonly used employee forms appear below for your convenience. Many are screen-fillable. Please click on the form number to access the form. Please be aware that not all forms are applicable to all employees.
Please scroll down to view the complete list. If you have any questions, contact the Director of Human Resources for assistance.LEAVE FORMS
DOL-WH380E FMLA Health Care Provider Form-Employee's Own Health Condition DOL-WH380F FMLA Health Care Provider Form-Family Member's Health Condition DOL-WH384 FMLA Military Leave-Qualifying Exigency DOL-WH385 FMLA Military Leave-Covered Service Member's Health Condition HPS-L1 Request for Leave or Approved Absence - Screen Fillable Form HPS-L1.5 Request for Leave or Approved Absence - Manually Fillable Form HPS-L2 Advanced Leave Agreement HPS-L3 FMLA Employee Form (Non-HTA) HPS-L4 FMLA Employee Form (HTA)
BENEFIT FORMS - Miscellaneous
HPS-B1 Section 125 Cafeteria Plan Employee Waiver/Election & Compensation Reduction Agreement HPS-B3 Employee Assistance Program (EAP) Information HPS-B4 FY 18 Health & Basic Life Insurance Rate Chart OMB 1210-0149 Health Insurance Marketplace Coverage Notice TOH-B1 Town of Hopkinton HIPAA Privacy Notice TOH-B2 Town of Hopkinton HIPAA Privacy Acknowledgement
BENEFIT FORMS - Flexible Spending AccountsBENEFIT FORMS - Health Insurance (Medical)
BCBS-1 BCBS Enrollment and Change Form Med-Dent BCBS-2 BCBS HMO Blue New England Value+ Plan Summary BCBS-3 BCBS HMO Blue New England Deductible Plan Summary BCBS-4 BCBS PPO Blue Care Elect Value+ Plan Summary BCBS-5 BCBS Dental Blue LOW BCBS-6 BCBS Dental Blue HIGH BCBS-7 BCBS Dental Rollover Information BCBS-8 BCBS Fitness Reimbursement Form BCBS-9 BCBS Weight Loss Reimbursement Form HPS-B4 FY 18 Health & Basic Life Insurance Rate ChartBENEFIT FORMS - Long-Term Disability InsuranceBENEFIT FORMS - Life InsuranceRETIREMENT PLAN FORMS MCR-1 Middlesex County Retirement Board Enrollment Form OBRA-1 OBRA (Mandatory Deferred Comp Plan) Information Sheet OBRA-2 OBRA Acknowledgement Card OBRA-3 OBRA Withdrawal Form and Instructions OMNI-1 403(b) Information Sheet and Salary Reduction Form OMNI-2 Approved 403b Plan Vendor List OMNI-3 OMNI 403b Participant Website Instructions OMNI-4 403b Loan Withdrawal Form OMNI-5 403b Hardship Withdrawal Form OMNI-6 OMNI 457 Salary Reduction Form R000-RCEI MTRS Enrollment Assignment Sheet TOH-B3 Town of Hopkinton Retiree Exit Form (to elect retiree health benefits)PROFESSIONAL DEVELOPMENT FORMS HP-PD Instructions Coursework Procedures Information Sheet Teachers HPS-PD1 Request for Conference Attendance HPS-PD2 Intent to Submit Teachers HPS-PD3 Course Approval Teachers HPS-PD3F Course Approval Form Food Service Workers HPS-PD3P Course Approval Form Paraprofessionals HPS-PD4 Tuition Reimbursement and/or Course Credit Request Teachers HPS-PD4F Course Reimbursement Request Food Service Workers HPS-PD4P Course Reimbursement Request Paraprofessionals HPS-PD6 Inservice Course Credit Award Program Guidelines Teachers HPS-PD7 Inservice Course Credit Approval Teachers HPS-PD8 Inservice Course Certificate of Successful Completion TeachersPERFORMANCE EVALUATION TEMPLATESRECRUITING FORMS FOR ADMINISTRATORS HPS-CR Candidate Interview Rating Sheet-Numerical Score Format HPS-CR1-LIK Candidate Interview Rating Sheet-Likert Scale Format HPS-R1 Request for Approval to Begin Hire HPS-R2 Highly Qualified Teacher Checklist HPS-R3 Highly Qualified Teacher Status Certificate HPS-R4 Recommendation to Hire HPS-R5 Release & Waiver of Confidentiality HPS-R6 Interview Confidentiality Statement HPS-REF1 Reference CheckMISCELLANEOUS NEW HIRE FORMS BC-1 Background Check: How To Register for Fingerprinting BC-2 SAFIS Fingerprinting Registration Guide BC-3 Acceptable Forms of ID for Fingerprinting Appointment FED-I9Y Employment Eligibility Verification (I-9) GCN-1 Global Compliance Network (GCN) Training User Instructions MA-EP Employment Permit Application for 14 through 17 year-olds SSA-0510007 Government Pension Offset Fact Sheet SSA-0510045 Windfall Elimination Provision Fact Sheet SSA-0510051 How State & Local Government Employees Are Covered by Social Security & Medicare SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social SecurityPAYROLL FORMS FED-W4 Employee's Withholding Allowance Certificate (Federal W-4) HPS-P1 Direct Deposit Request HPS-P2 Direct Deposit E-Mail Authorization HPS-PYDT FY 18 Pay Date Schedule HPS-TA1 Non-Exempt & Contingent Employee's Time Sheet HPS-XPAY Extra Work Presented for Payment Form MA-M4 MA Employee's Withholding Exemption Certificate (MA M-4)MISCELLANEOUS FORMS HPS EH Employee Handbook HPS-EHA Employee Handbook Acknowledgement Form-Understanding by Employee HPS-EIR Employee Personal Injury Report HPS-EX1 Mileage & Expenses Reimbursement Request (non-HTA) HPS-GBEBC Employee Disclosure of Gifts HPS-M1 Employee's Request for Reasonable Accommodation MA-ETH Summary of the Conflict of Interest Law for Municipal Employees MA-ETHACK Employee Acknowledgement-Summary of Conflict of Interest Law TOH-M1 Town of Hopkinton Hold Harmless for VolunteersSUBSTITUTE PACKET FOR ADMINISTRATORS FED-I9Y Employment Eligibility Verification (I-9) FED-W4 Employee's Withholding Allowance Certificate (Federal W-4) HANDBK Substitute Handbook HDBK-ACK Understanding by Substitute (Handbook Acknowledgement) MA-ETH Summary of the Conflict of Interest Law for Municipal Employees MA-M4 MA Employee's Withholding Exemption Certificate (MA M-4) OBRA-1 OBRA (Mandatory Deferred Comp Plan) Information Sheet OBRA-2 OBRA Acknowledgement Card OMB 1210-0149 Health Insurance Marketplace Coverage Options Notice SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security SUB PAY Substitute Pay Rate Information SUB-1 Substitute Teacher/Nurse Packet Instructions SUB-2 Substitute Teacher Application SUB-3 Substitute Interview Rating Form SUB-3 Substitute Teacher Job Description SUBN-2 Substitute Nurse Application