Admin Forms

Human Resources

Customer Service
Employee Complaint Form
-Your Voice Your Thoughts English Version / Spanish Version

Insurance
20-21 Employee Benefits Program (Sonoma County)
20-21 Employee Benefits Program (Mendocino and Lake Counties)
USleb: Free Mobile Benefits App
Medicare Prescription Drug Coverage 2019
2014 Health Reimbursement Arrangement Welcome Packet
-Participant Quick Start Guide
Submit Your Claim Receipt (Open in Google Chrome-
https://ebsbenefits.lh1ondemand.com)

There are a few ways to get reimbursed:

• Follow the hyperlink on the first page of the Welcome Packet. You will fill out your info, and attach scanned copies of your receipts.
• Print and fill out the second page (it can be mailed or faxed, but faxing should have the quickest turnaround.)
• Download the EBS app.

Logging in the first time will be your first initial, last name, and last 4 of your ssn.

Employment
Consumer Action Form
Employment Application Form
Personnel Action Form (PAF) 2018 Instructions
Personnel Requisition Form (PRF) 2018  Instructions
Resignation Notice

Payroll
Authorization for Direct Deposit
Exempt Exception Form
Meal Period Waiver
Overtime Approval
Time Off Request
Timesheet for Regular Employees
W-4 Form
Unpaid Time Off Request