5. Orientation Forms
The following forms are necessary to establish your record in the payroll system. You are required to complete forms immediately and in no case later than 3 days after your appointment date. Once you have printed off the forms, refer to this guide for specific information on each form. It is important for you to complete the forms prior to meeting with your supervisor/administrative staff, who will provide you with more information about your own duties, your work unit, and specific information for your department. If you have any questions, please contact the Employee Call Center at 465-3009.
The following New Employee Forms Checklist should be printed prior to printing the forms. Complete the forms in the order that is posted for easy reference for yourself and your supervisor when you turn in the forms.
Employment Eligibility Verification: (Required)
The Federal Immigration Reform and Control Act of 1986 requires all United States employers to verify and document each new employee's identity and authorization to work in the United States. You must complete the Employment Eligibility Verification form and provide the required documentation within 3 days of your date of hire. You, as the employee, must complete Section 1 of the form; Section 2 will be completed by your supervisor/department representative.
Form W-4 (Employee Withholding Allowance Certificate): (Required)
This form advises the state of your federal tax withholding status. This designation will determine the amount of taxes to be withheld from your salary. If you are not sure what deductions to take, use the worksheets on page 1 and 2 of the form. You may change your deductions whenever you need to by submitting a new W-4 to the Technical Service office.
Employee Affidavit: (Required)
Under Alaska Statute, state employees are required to swear (or affirm) an oath of office. This oath must be signed by the employee and witnessed by a department representative (administrative staff or supervisor). The form also provides an area for the employee to designate a person or persons to be notified in the event of serious illness or accident.
Address Authorization/Change Form: (Required)
This form provides the employer with the employee's resident mailing address. If the option for direct deposit is not exercised it provides an address for mailing payroll warrants.
Confidentiality of Information Acknowledgment
In the course of work, employees may be responsible for handling confidential or sensitive information. Steps should be taken to prevent the exposure of this information to individuals without a business need or legal right to know.
Payroll Direct Deposit Form
This offer to participate in electronic direct deposit complies with AS 37.25.050 and 2 AAC 15.130. Do not fill out this form if you wish to decline the offer. The optional form authorizes a direct deposit of the payroll warrant to a financial institution of the employee's choice. Processing of this authorization through the state payroll system will require two pay periods to complete. You will need to attach to the form a voided check or savings account deposit slip of the account to which you want your payroll warrant directed.
Equal Employment Opportunity Survey: (Required)
This information will be used in statistical calculations only for federal and state EEO reporting requirements.
Union Notification Form: (Required for all except XE & PX Employees)
Your position is probably governed by one of several unions representing state employees. Your supervisor will tell you which union represents your position. You are required to contact the appropriate union within a specified timeline. These forms will give you contact information regarding union membership and document your receipt (with your signature) of this information. Note: There is a separate form to download for ASEA (GGU) members.
Ethics Disclosure (Required for Outside Employment)
Per AS 39.52.170 (b), the Executive Ethics Act, employees are required to provide notice of employment or provision of services for compensation outside of the state's employment system. While volunteer work is not required to be disclosed under statute, employees who have any business or personal interest outside the state's employment system must also complete this form.
If this does not apply, you do not need to submit this form.
Prior Service Verification: (Optional)
This form will be used to determine the amount of leave you will accrue each pay period. You may receive credit for time previously spent in a qualifying leave accruing position and may accrue leave at a higher rate adjusted for your prior service. If you have never worked for the State of Alaska previously, you do not need to submit this form.
Second Injury Fund Questionnaire: (Required)
The purpose of this questionnaire is to preserve the employer's right to obtain Second Injury Fund reimbursement if you suffer a work-related injury in employment. This will be retained in a confidential medical file.
Drug Free Workplace Act: (Required)
This form is to ensure you are aware of the state's policy on drugs and alcohol, both in and outside of the workplace. You are required to read and sign the form, which will be placed in your personnel file.
Read the State of Alaska Drug Free Workplace Policy (pdf) here.
The following are the Administrative Orders that you are required to read. The signature form needs to be printed and signed, acknowledging that you have read the orders.
- Family and Medical Leave Act
- Americans with Disabilities Act (AO 129)
- Equal Employment Opportunity (AO 75)
- Sexual Harassment and Other Discriminatory Harassment (AO 81)
- Diversity in the Workplace (AO 195)
- Business Use/Acceptable Use ISP-172 (Personal Use of Office Technology Policy)
- State of Alaska Ethics Information for Public Employees (AS 39.52)
- Policy on Seat Belts (AO 85)
- Statewide Policy Acknowledgement Form (Print)(Required)
Social Security Form (SSA-1945) (Required)
The Social Security Protection Act of 2004 requires state and local government employers to provide a statement to employees hired January 1, 2005 or later in a job not covered by social security. The statement explains how a pension from that job could affect future social security benefits to which you may become entitled.
Designation of Beneficiary for Unpaid Compensation: (Required)
In the event of an employee's death, this form is used to identify beneficiaries for any unpaid compensation (monies owed for work or leave) that an employee has earned. The total percentage for primary beneficiaries must add up to 100% and the total percentage for contingent beneficiaries, if a primary beneficiary is not living, should also be 100%. This form also needs to be witnessed by a departmental representative (administrative staff or supervisor).
Retirement Beneficiary Designation Form (PERS/TRS): (Required for all FT and PT Permanent/Probationary employees)
(If you are in a Nonpermanent or Intern position you are not eligible for Retirement benefits, therefore you do not need to complete this form)
In the event of an employee's death, this form is used to identify beneficiaries for retirement system benefits that the employee has earned. The total percentage for primary beneficiaries must add up to 100% and the total percentage for contingent beneficiaries, if a primary beneficiary is not living, should also be 100%. This form also needs to be witnessed by a departmental representative (administrative staff or supervisor).
- PERS Tier IV Defined Contribution Retirement Plan Beneficiary Form
- TRS Tier III Defined Contribution Retirement Plan Beneficiary Form
- PERS Tier I, II, III / TRS I, II Defined Benefit Retirement Plan Beneficiary Form
Supplemental Annuity Plan Beneficiary Form: (Required)
In the event of an employee's death, this form is used to identify beneficiaries for Supplemental Annuity mandatory benefits that an employee has earned. The total percentage for primary beneficiaries must add up to 100%. The total percentage for contingent beneficiaries, if a primary beneficiary is not living at the time of payment, should also be 100%.
Basic and Select Life Insurance Enrollment or Change Form:
(If you are not eligible for health insurance you do not need to complete this form)
Both Basic and Select Life Insurance are available to most State of Alaska employees. This form is used both to enroll for the benefit and to identify your beneficiaries. The total percentage for primary beneficiaries must add up to 100% and the total percentage for contingent beneficiaries, if a primary beneficiary is not living, should also be 100%.
Download Select Life Insurance Worksheet (For Your Information)
Optional Benefits Beneficiary Form: (Optional)
In the event of an employee's death, this form is used to identify beneficiaries for Supplemental Life, Accidental Death and Dismemberment, or Survivor insurance that an employee has elected. The total percentage for primary beneficiaries must add up to 100%. The total percentage for contingent beneficiaries, if a primary beneficiary is not living at the time of payment, should also be 100%.
Health Insurance Forms
The following forms are for Health Insurance eligible employees only (Permanent Full-Time, Permanent Part-Time, Permanent Seasonal, or Long-Term Nonpermanent employees)
Union Health Trusts
The following employee groups are covered by Union health trusts and the Trust should be contacted for details.
- General Government (GGU)
- Labor, Trades and Crafts (LTC)
General Government Union (GGU)
Contact your General Government Union Health Trust for enrollment information at 866-553-8206
This form provides the ASEA Health Benefits Trust with the information that is needed for health insurance enrollment. An information packet, with additional forms will be mailed to you directly from the Trust. It is the responsibility of the employee to fax this to the GGU Health Trust. (The fax number is on the form.)
Labor, Trades & Crafts (LTC)
Information can be found at http://www.local71.com.
You will need to complete online enrollment at the Division of Retirement and Benefit's website if you are in one of the following groups:
- Correctional Officers
- AVTEC Teacher's Association
- TEAME (Mt. Edgecumbe Teachers)
- Employees not covered by collective bargaining
This new employee orientation program and forms are developed and maintained by the DOA/DOPLR. State benefit programs and cost and general employer/employee policies can be affected by changes in state or federal law, state regulation and/or state benefit programs. DOA/DOPLR attempts to keep this information current on a regular basis and, in that reguard, disclaims responsibility for conveying employer benefit program and cost information or employer policies that may have changed in the interim.