Employee Forms

Appraisal Forms

  1. Evaluation Form (PDF)
  2. SMART Goal Sheet (PDF)

Benefit Forms 

  1. AF Flex Claim Instructions (PDF)
  2. Change of Beneficiary Form (PDF)
  3. Employee HSA Payroll Deduction (PDF)
  4. Securian Life Insurance Beneficiary Designation Form (PDF)
  5. Short-Term Disability Claim Form (PDF)

Compensation Forms 

  1. Essential Functions Questionnaire (PDF)
  2. Job Detail Assignment Form (PDF)
  3. Management Detail Appointment MDA Form (PDF)
  4. Position Description Questionnaire (PDQ) (PDF)
  5. Supervisory Position Supplemental Questionnaire (PDF)

Employee Acknowledgement Forms 

  1. Cell Phone Usage Acknowledgment Form (PDF)
  2. Personnel Status Change Form (PDF)

Employee Information Forms 

  1. Direct Deposit Form (PDF)
  2. Outside Employment Declaration (PDF)
  3. Pinal County Change of Address-Name (PDF)
  4. W-4 Form (PDF)
  5. A-4 Arizona Tax Withholding (PDF)

Family & Medical Leave Forms 

  1. Certification for Serious Injury Illness of a Current Service Member--For Military Family Leave - WH 385 (PDF)
  2. Certification of Health Care Provider for Employee Medical Leave - WH 380-E (PDF)
  3. Certification of Health Care Provider for Family Medical Leave - WH 380-F (PDF)
  4. Certification of Qualifying Exigency For Military Family Leave - WH-384 (PDF)
  5. Certification of Serious Injury Illness of a Veteran--For Military Caregiver Leave - WH 385-V (PDF)
  6. FMLA Request Form (PDF)

New Hire Orientation Forms 

  1. Compensatory Time Agreement (PDF)
  2. Drug Free Workplace Policy Statement (PDF)
  3. I-9 Form (PDF)
  4. Loyalty Oath (PDF)
  5. New Employee Questionnaire (PDF)
  6. Personnel Policy Receipt Acknowledgment (PDF)
  7. Policy Acknowledgement (PDF)
  8. Statement of Use and Confidentiality (PDF)

Retirement Forms 

  1. 2017 NRS Health Care Fact Finder (PDF)
  2. ASRS Long Term Disability Application (PDF)
  3. ASRS Return to Work Form (PDF)
  4. AZ Direct Rollover (PDF)
  5. NACo Participation Agreement (PDF)
  6. Nationwide Beneficiary Change Form (PDF)
  7. Nationwide Deferred Comp Enrollment and Change Form (PDF)
  8. Nationwide Retirement Options Booklet (PDF)
  9. NW Name Address Beneficiary Change Form (PDF)
  10. NW Payroll Authorization Change Form (PDF)
  11. PSPRS - Address and Name Change Form (PDF)

Termination Forms 

  1. Authorization for the Release of Information (PDF)
  2. Resignation Letter (PDF)
  3. Separation Clearance Form (PDF)

Training Related Forms 

  1. Department Meeting Minutes Form (PDF)
  2. Training Service Agreement (PDF)
  3. Training Service Commitment (PDF)

Vacation & Other Leave Forms 

  1. Families First Coronavirus Response Act (FFCRA) Leave Request Forms (PDF)

Vehicle Forms 

  1. Notification of Assignment of County Vehicle (PDF)
  2. Trip Exception Form (PDF)
  3. Vehicle Emergency Log (PDF)
  4. Vehicle Use Log (PDF)

Volunteer Forms 

  1. Volunteer Packet-Complete (PDF)
  2. Volunteer Service Agreement (PDF)
  3. Volunteer Status Checklist (PDF)

Workers Compensation / Risk Forms 

  1. ACIP Temporary Prescription Fill Form (PDF)
  2. Employees Report of a Vehicle-Equipment Accident (PDF)
  3. Exposure Instructions Sheet (PDF)
  4. Incident Report (PDF)
  5. Notice of Claim Against Pinal County (PDF)
  6. Notice of Claim Against Pinal County Spanish Version (PDF)
  7. Supervisors Report of Industrial Injury Instructions and Form (PDF)
  8. Supervisors Vehicle Equipment Investigation Report (PDF)
  9. Vehicle Accident Incident Procedure (PDF)