Please contact us for any and all questions concerning these topics:
- Benefits & Insurance Programs
- Compensation
- Continuing Education & Training
- Corporate Compliance
- Harassment
- HIPAA/Confidentiality & Red Flags/Privacy
- HR Policy & Processes
- Risk & Safety Management
Forms
Here is a list of Human Resource forms for download and quick reference. Each Link is a PDF and can be filled out, emailed, faxed or delivered in person to your supervisor or HR.
- Change In Employee Status Form
To be completed when you want to apply for an open position, increase or decrease your hours on a more permanent basis. - Leave Of Absence Form
To be completed if you are requesting time off that your PTO will not cover. - Makeup Time Request Form
To be completed when you take some time off on one day (not the whole day) and make up the time on another day, during the same work week. - SNF Occupational Therapy Timesheet
- SNF Speech Therapy Timesheet
- Temporary Schedule Change Form
To be completed when you are going to substitute a different day for a regularly scheduled day during the same workweek. - Unsafe Work Conditions Report Form
To be completed if you have observed an unsafe condition in your work environment. - Unusual Occurrence Report Form
To be completed if a patient or visitor or vendor sustains an injury, or possible/actual exposure or displays upset regarding service. Upon completion, fax to 916-983-5932.
NOTE: THIS FORM IS NOT TO BE COPIED, NOR PLACED IN THE PATIENT CHART - Workers Compensation Form
To be completed if you sustain an on-the-job illness or injury or possible/actual exposure.
NOTE: You must also complete the Employers Incident Report Supplemental Form
Employee Assistance Program:
Reliance Standard EAP Employee Assistance: http://rsli.acieap.com/
Medical Insurance:
Blue Shield: www.blueshieldca.com
Kaiser: www.kaiserpermanente.org
Vision Insurance:
Superior Vision: https://www.superiorvision.com
Dental Insurance:
Cypress Ancillary Benefits: http://www.cypressadmin.com
Voluntary Insurance Programs:
Celita Pedro
AFLAC Representative
Email: Celita_pedro@us.aflac.com
Phone: (916) 396-4233
(401k) Retirement Program Information:
Phone: (888) 401-5629
Website: Newport Group