- 2022 W-4 Form
- Applicant Summary
- Authorization for Release of Information
- Cafeteria Plan Reimbursement Form
- Chronic Form
- Direct Deposit Form
- Donated Leave Form
- Employee Assistance Program
- Entry and Exit Checklist
- First Report of Injury or Illness Form
- Flex Time Work Schedule Request Form
- FMLA Certification Form (Employee)
- FMLA Certification Form (Family Member)
- Form I-9, Employment Eligibility Verification
- Form P-1, "Request to Recruit for Employment"
- Form P-2, "Employment, Promotion or Transfer Request"
- Form P-3, "Termination of Employment"
- Grievance Form
- Health Insurance Plan Application for Coverage
- Leave Form
- MDE Contract Worker Background Acknowledgement
- Mississippi State Tax Form
- Monthly Time Report
- Request for Donated Leave
- Telephone Reference Check
- Telework Assignment Form
- Workers' Compensation Packet
- Physicians' Certification for Donated Leave
- Fraud Waste & Abuse Policy Acknowledgment
- Code of Ethical Conduct Policy Acknowledgment
- Code of Ethical Conduct Policy for Accounting & Finance Employees Acknowledgment
- Related Party and Nepotism Acknowledgment
- Related Party Questionnaire
CONTRACT WORKER FORMS
FORMS TO BE COMPLETED BY CONTRACT WORKER
- Form W-4 - IRS tax form
- State Withholding Form Mississippi Employee’s Withholding Exemption Certificate
- Certification of PERS Service Retirement The SBE must approve contracts with former state employees who are PERS retirees receiving retirement benefits for an amount exceeding $20,000 a year.
- Direct Deposit Form
- Information Change Form - Name, Address, etc.
FORMS TO BE COMPLETED BY CONTRACT WORKER AND REQUESTING OFFICE:
- PERS Form 4B (only complete if contract worker is a PERS retiree)
- Form I-9 - Employment Eligibility Verification
- Background Acknowledgement and Authorization to Release Information (with Human Resources approval) Note: If there is not a break in service from the prior fiscal year then no additional background check is required. However, if there is a break in service, then another background check is required.
- Telephone Reference Check, Please complete this form for each reference check done on behalf of the candidate.
- Certification of School District/Public Entity (Only complete if contractor is a school district or public entity employee.) Form to be completed by contractor and requesting office. The form can be modified if employment is other than a school district.