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Hazleton Area School District

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CVS Benefit Summary Description 2019

CVS Benefit Summary Description 2019.pdf 461.28 KB (Last Modified on July 17, 2019)

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Davis Vision Enrollment/Change Form

Davis Vision Enrollment Form 5 9 18.pdf 35.9 KB (Last Modified on July 17, 2019)

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Delta Dental Enrollment/Change Form

Delta Enrollment-Change Form 5 9 18.pdf 15.88 KB (Last Modified on July 17, 2019)

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ESPA Grandfathered Staff Group Term Life Benefits

B7RJLife_C6_090319 ESPA GRANDFATHERED.pdf 290 KB (Last Modified on September 17, 2019)

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ESPA Group Term Life Benefits

B7RJLife_C2_090319 ESPA.pdf 290.14 KB (Last Modified on September 17, 2019)

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HAEA PT Teachers Group Term Life Benefits

B7RJLife_C5_090319 HAEA PT TEACHER.pdf 290 KB (Last Modified on September 17, 2019)

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Highmark Change Form

Highmark Change Form 5 9 18.pdf 65.09 KB (Last Modified on July 17, 2019)

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Highmark Enrollment Form

Highmark Enrollment Form 5 9 18.pdf 75.01 KB (Last Modified on July 17, 2019)

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Long Term Absence Form

Longterm_Absence_Form_20180814.docx 29.25 KB (Last Modified on January 10, 2019)

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Mutual of Omaha Beneficiary Form

Mutual of Omaha Beneficiary Form.pdf 96.72 KB (Last Modified on July 17, 2019)

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PPO 500 SBC

PPO 500 SBC.docx 569.58 KB (Last Modified on July 17, 2019)

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PPO HSA 2000 SBC

PPO HSA 2000 SBC.docx 568.96 KB (Last Modified on July 17, 2019)

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PSERS Nomination of Beneficiary

psers_beneficiary.pdf 217.86 KB (Last Modified on January 28, 2015)

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Safety Inspection Checklist

safety_inspection.pdf 238.56 KB (Last Modified on January 28, 2015)

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Security Group Term Life Benefits

B7RJLife_C4_090319 SECURITY.pdf 289.99 KB (Last Modified on September 17, 2019)

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Teamsters Group Term Life Benefits

B7RJLife_CertSum3_090319 TEAM.pdf 97.15 KB (Last Modified on September 17, 2019)

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US Imaging Welcome Letter

Welcome_ Letter_US_Imaging.pdf 315.58 KB (Last Modified on January 28, 2015)

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WH 380 FMLA form for EMPLOYEE leave

WH-380-E.pdf 388.52 KB (Last Modified on September 1, 2020)

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WH 380 FMLA form for FAMILY MEMBER leave

WH-380-F.pdf 485.01 KB (Last Modified on September 1, 2020)

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Worker's Compensation Packet 2019-2020

WC_Packet_2019-2020.pdf 1.03 MB (Last Modified on July 10, 2019)

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