89 Hayden Rowe Street | Hopkinton | MA 01748 | Phone: 508-417-9360 | Fax: 508-497-9833

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
 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
 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 Accounts
 HRC-1  Flex Spending (Health and/or Dependent Care) Enrollment Form
 HRC-2  Flexible Spending General Information
 HRC-3  Flexible Spending Claim Form

BENEFIT 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-Rate  Health Insurance Rates
BENEFIT FORMS -  Long-Term Disability Insurance
 SL-1  Sun Life Long-Term Disability Enrollment Form
 SL-2  Sun Life Long-Term Disability Claim Form
 SL-3  Sun Life Long-Term Disability Evidence of Insurability Form
 SL-4  Sun Life Long-Term Disability Program Outline
BENEFIT FORMS -  Life Insurance
 BOS-1  Boston Mutual Life Evidence of Insurability Form
 BOS-2  Boston Mutual Authorization for Release
 BOS-3  Boston Mutual Life Enrollment/Declination Form
 BOS-A  Boston Mutual Voluntary Life Information
RETIREMENT 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-PD5  Summer Curriculum Project Proposal Teachers
 HPS-PD6  Inservice Course Credit Award Program Guidelines Teachers
 HPS-PD7  Inservice Course Credit Approval Teachers
 HPS-PD8  Inservice Course Certificate of Successful Completion Teachers
PERFORMANCE EVALUATION TEMPLATES
 HPS-EVALSS/AA  Evaluation Form - Secretarial Support/Administrative Assistants
 HPS-EVALTA/GenEd  Evaluation Form - General Education Teaching Assistants
 HPS-EVALTA/Library  Evaluation Form - Library Assistants
 HPS-EVALTA/SpEd  Evaluation Form - Special Education Teaching Assistants
RECRUITING 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 Check
MISCELLANEOUS 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)
 HPS-NH1  District Property Inventory
 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 Security
PAYROLL 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 Volunteers
SUBSTITUTE 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
 OBRA-3  OBRA Smart Plan Information Guide
 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

CLOSE