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New Hire Enrollment Packets

New Hire Enrollment Packets may be accessed by selecting the applicable state. Please forward completed packets to your Payroll Tech upon hiring.

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BenefitsEnglishSpanish
ESC 5500 Bronze Plan Offer Acknowledgement Form - English
ESC Reference Manual 2020-2021 - English
ESC Weekly Change Form
ESC Weekly Enrollment Form
ESC Plan 1 Outline
ESC Plan 2 Outline
ESC Plan Design Summary Form
Claims AdministrationEnglishSpanish
Accident Investigation Report
CA State Claim Form (DWC-1)
Claims Reporting Procedures Packet
Consent for Release of Medical Information
Employee Refusal of Medical Treatment
Claims Reporting Procedures Flowchart
Workers' Compensation Claim Protocols
New Hire Safety Orientation Checklist
Post Accident Safety Sign Off Sheet
Safety Meeting Sign Off Sheet
Safety Suggestion Form
Client Work Site Safety Evaluation
Certificate Request Form
New Class Code Location Request
Class Code Addition Staffing
Payroll AdministrationEnglishSpanish
Direct Deposit Form
Direct Deposit Cancellation Form
Direct Deposit Reversal Affidavit Form
Employee Data Change Form
Employee Separation Form
New Hire Packet Input Form
Progressive Discipline Program Form
Hire Packets for California
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