Human Resources Forms


Aflac

Basic

CALPERS MEDICAL,DENTAL,VISION AND OPTIONAL LIFE INSURANCE RATES
Effective 1/1/2021
Mayor and City Council
($1,594.00 Monthly Allowance w/ Cap)
Full-Time and CPT Employees - City Clerk and City Treasurer
($1,594.00 Monthly Allowance w/ Cap)
Eligible Part-Time and Temporary Employees
($143.00 Monthly Allowance)
Eligible AFSCME Part-Time Employees w/8 years plus
($457.00 Monthly Allowance for Optional Benefits)
CPSA and AME Hired After 01-01-18
($1,594.00 Monthly Allowance w/ Cap)

CalPERS Medical, Dental, Vision and Optional Life Insurance Rates - Effective 7/1/2020
Mayor and City Council
($1,594.00 Monthly Allowance w/ Cap)
Full-Time and CPT Employees - City Clerk and City Treasurer -
($1,594.00 Monthly Allowance w/ Cap)
Eligible Part-Time and Temporary Employees -
($139.00 Monthly Allowance)
Eligible AFSCME Part-Time Employees w/8 years plus -
($453.00 Monthly Allowance for Optional Benefits)
CPSA and AME Hired After 07-01-18
($1,594.00 Monthly Allowance w/ Cap)
CalPERS:
CalPERS Website Forms: https://www.calpers.ca.gov/page/forms-publications
CalPERS Long-Term Care: https://www.calperslongtermcare.com/
 
CIGNA:
Cigna EAP Video
City of Carson Full Time Employee EAP Brochure (PDF)
City of Carson Full Time Employee EAP Flyer (PDF)
How to Report a Life ADD Claim (PDF)
How to Report an STD LTD Claim (PDF)
Value Add Descriptions Cigna (Life ADD) (DOC)
Group/Association - Short Term Disability Benefits (PDF)
Group Long Term Term Disability (PDF)
 
CIGNA - Group Life Insurance :
Notice of Protection (PDF)
 
Colonial Life
 
  FMLA, CFRA and other Leave Information and Forms
FMLA - HR Director Memo
CFRA and PDL Leave - HR Director Memo
Request for Leave of Absence Form
Certification of Health Care Provider - Employees Own Condition
Certification of Health Care Provider - Family Member Condition
CDFEH - FMLA, CFRA AND PDL - Notice B
FMLA - Bonding Leave
FFCRA(Families First Coronavirus Response Act) Leave Notice
 
PARS (Public Agency Retirement Services)
PARS - General Information (PDF)
PARS - Request for Distribution (Fillable PDF)
PARS - Designation of Beneficiary Form (PDF)
 
PRINCIPAL DENTAL:
https://www.principal.com/providers/dental-providers
Principal Dental Benefits - Dental Expense Coverage (PDF)  
Provider Operations Guide (PDF)  
Principal Dental Access Benifits (PDF)  
 
 
SUPERIOR VISION:
https://superiorvision.com/
 
OTHERS:
LegalShield Legal Protection (PDF)
Ameriflex: https://www.myameriflex.com/
 
VOYA 457 DEFERRED COMPENSATION: https://www.voya.com/
 
New Hire Clearance Packets
Standard New Hire Packet New!  
Adults Aquatics New Hire Clearance Packet New!  
Part-Time Minors New Hire Clearance Packet New!  
Part-Time / Temp / Sports Officials (Non-Minors) New Hire Clearance Packet New!
 

City Hall Contact

701 E Carson Street
Carson, CA 90745
(310) 830-7600, 7 AM - 6 PM
Monday - Thursday
24-hour automated: (310) 952-1700

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