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SUPERVISORY FORMS

Pay-4-Performance

Pay-4-Performance Page and Training Schedule

(Personnel Rule Chapter 3 - PR-304)

Personnel Action Form (PAF)
1 Form

PAF Form {Word Doc}
PAF Form [PDF]

New Hire - Employee Eligibility Verification I-9 Form - please see Human Resources

Recruitment & Selection Process

Requisition for Open Position
2 Forms

County Request Form  {Word Doc}

Courts Request Form   {Word Doc}

Reallocation of position or Reclassification of position [PDF]
Please see YUMA County Rules & Regulations or contact Human Resources

Vacancy Review is a comprehensive term that permits Human Resources to assess and discuss the need to fill employment vacancies (promotions, transfers, and new hires) that are compensated from the General Fund or other County funding source. The Vacancy Review does not apply to certified public safety personnel. 1 Document & 1 Form

Vacancy Review Memo [PDF]

Vacancy Review Policy [PDF]

Voluntary Grade Decrease Request
1 Form
Voluntary Grade Decrease Request Form  {Word Doc}

CHAPTER VIII (Grievance And Disciplinary Procedures) & Forms 

View: Grievance & Disciplinary Webpage to download individual forms

Workplace Posters (required by the Federal & State government) 

For more information on workplace posters please contact Human Resources.

Jessica Rodriguez, Employee Relations Analyst
Phone: 928-373-1163
Fax: 928-373-1078 
e-mail: Jessica.Rodriguez@yumacountyaz.gov

EMPLOYEE FORMS (used by all employees)

Colonial Supplemental Insurance
2 Forms

Claim Form and Instructions [PDF]
Request for Service Authorization Form [PDF]

Employee Assistance Program (EAP)

Provided by Support Linc - visit Website for EAP Health Care Services
 Phone: 1 (888) 881-5462 or call Benefits for assistance at (928) 373-1165

Employee Extended Illness Bank (EIB)
1 Document & 2 Forms

EIB Rule Document (CHAPTER IV (BENEFITS) PR-417) [PDF]
Donation Form [PDF]
Application Form [PDF]

Employee Tuition Reimbursement Program
1 Document & 1 Form

Tuition Reimbursement Rule Document and Form [PDF]
(CHAPTER IV (BENEFITS) PR-419)

Family Medical Leave (FMLA)
Document & Forms

View: Yuma County FMLA Webpage

Flexible Spending Account (FSA) Documents & Forms

View: FSA Webpage

SSA Mexico Network (YCEBT PPO)
2 Forms

View: SSA Webpage

PERSONAL INFORMATION FORMS

Change of Address or Name 

1 Document & 2 Forms

Name Change Procedure [PDF] 

Name Change Forms: Please call Human Resources 928-373-1013

(See Name Change Procedure for other required forms)

Address Change Form [PDF] (please notify your Retirement System)

Direct Deposit - 1 Form

Direct Deposit Form [PDF]

Retirement (Change in Address, Name, Beneficiary. etc.)
5 Forms

Arizona State Retirement Forms (ASRS) (online forms)
Correction Retirement (CORP) (online forms)
Court Corrections Officer Retirement (ACORP) (Please call Human Resources (928) 373-1013
Public Safety Retirement (PSRS) (online forms)
Elected Official Retirement (EORS) (online forms)

Federal Tax Forms
1 Form

(Required for any change in name, status, dependents, etc.)
Federal Tax Form - W4   [PDF]

Arizona State Tax Form
1 Form
State Tax Form - A4  [PDF]

YCEBT Additional Benefit Information & Forms

View: Benefits Webpage or contact Benefits at (928) 373-1165

OTHER FORMS

Wellness Program

Age Related Physical Exam Acknowledgement
1 Form

Physical Attestation Form  [PDF]

Relocation Policy
1 Document & 1 Form

Relocation Form

(CHAPTER II (EMPLOYMENT) PR-209)

Request for Verification or Public Records

Please visit the County Administrator
'Reports, Permits and Forms' Webpage

1 Document & 1 Form

Request for Public Records Form  [PDF]

Request for Public Records Policy  [PDF]

Review Personnel File - 1 Form

Request Form [PDF]

Separation information, Exit Interview
Employees terminating employment with Yuma County, please see your immediate Supervisor or contact Human Resources - your Opinion counts.

We would appreciate you taking the time to fill out this form, and return it to the Human Resources office. If you specifically authorize, Yuma County would like permission to use the data to compile statistics.

Exit Interview - 1 Form

Exit Interview form  [PDF]

Environment, Health & Safety

Safety Excellence Award Program
Attention to safety is important, please feel free to nominate any county employee for this award.

1 Document & 1 Form


Safety Excellence Award Information Flyer
[PDF]

Award Nomination Form {Word Doc}

Contact Information

Yuma County Human Resources Department
Phone:
(928) 373-1013
Fax: (928) 373-1153
Office Hours: Monday - Friday, 8:00 a.m. to 5:00 p.m. 
Location: 198 S. Main St., Yuma AZ 85364

Call (928) 373-1113 with questions and comments or e-mail Debra.Hancock@yumacountyaz.gov

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