City of Kettering - Human Resources

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Human Resources

Frequently Used Forms

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Change of Address or Beneficiary (Form PE-9582)

Designation of Life Insurance Benefits

Direct Deposit Authorization Form

Educational Assistance Request (Form PE-3032)

Tuition Reimbursement for Future Years Request (Form PE-9578)

Tuition Advanced Reimbursement Request (Form PE-9579)

2013 Insurance Enrollment Forms -

2013 HSA Pre-Fund Request Form

2013 HSA Mid-Year Change Form

2013 Credit Union Comparison

2013 Wright Patterson Credit Union HSA Sign Up Form

2013 Day Air Credit Union HSA Sign Up Form

2013 CODE Credit Union HSA Sign Up Form

2013 HSA Employee Brochure

2013 United Health Care Change/ Cancelation Form

2013 City of Kettering Waiver of Insurance Form

2013 Dental Insurance Summary

2013 Dental Enrollment or Change Application

2013 Dental Insurance Student Verification

2013 HRA General Information Brochure

2013 Health Reimbursement Account Annual Enrollment Form

2013 HRA Request for Reimbursement - Claim Form

2013 Limited Purpose FSA Brochure

2013 Limited FSA Budgeting Worksheet

2013 Health Savings Account /FSA Annual Enrollment Form

FlexBank FSA Request for Reimbursement - Claim Form

FlexBank Employee Direct Deposit Authorization Form

FlexBank Dependent Care Request for Reimbursement Form

FlexBank Change of Status Form