Employee Required Document Checklists
Last Updated: 03/05/2020
Select the personnel action from the list below to get a list of the documents that need to be submitted and you can use the Employee Packet Checklist to make sure that all necessary forms get submitted.
Employee Packet Checklist (xlsx)
Please remember to have new employees go through the New Employee Orientation to familiarize themselves with the insurance, benefits, and other forms that need to be submitted.
Marine unit employees have additional required paperwork based on their union and will need to work with their supervisor to submit all appropriate paperwork.
IMPORTANT: Forms should not be printed out far in advance of the employee's start date due to updates that frequently occur. It is recommended that new employees read the information on the New Employee Orientation web page while completing their new hire packet.
Family Leave webpage provides information about FMLA / AFLA as well as the appropriate form packets.
Requirement Status Explanation
- RP = Required for Pay (these forms are required to be submitted within 5 calendar days of effective date in order to process pay for the employee)
- R = Required (these forms are required to be submitted within 30 days to finalize the payroll action for the employee)
- IA = If Applicable (these forms may be required in specific circumstances)
- ER = Employee Responsibility (these forms are the employee's responsibility to submit directly to the appropriate agency)
- O = Optional (these forms are optional to submit)
Please note that some documents have multiple requirements, for example RP / IA means that it is required for pay if applicable, or ER / O means that it is the employee responsibility, but it is an optional form.
Incomplete or Late Paperwork
Please note that all Required for Pay (RP) documents are due within 5 calendar days of the effective date for the employee to get paid in the regular payroll processing. If any RP documents are missing or they are received after the 5 calendar days, the employee will get paid via a supplemental warrant, which gets processed separate from regular payroll processing.
All other required (R) forms must be submitted within 30 days of the effective date to finalize the personnel action for the employee. Any forms listed as Employee Responsibility (ER) should be sent directly to the agency listed in the "Submit To" column.
DOP forms should be sent to the appropriate payroll email or fax based on the employee's department. This information is available on the first page of the Payroll Contact Sheet (PDF).
Acting Status
The following forms need to be submitted when an employee moves into acting status.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Acting Memo / Delegation | DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
Appointment - Boards & Commissions (STIPEND)
The following forms need to be submitted for new Boards & Commissions appointments / hires who receive a stipend for their attendance during meetings.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a Public Official Financial Disclosure (POFD) within 30 days of appointment. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| RP | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Attendance Sheet (PDF) | DOP-Payroll | Required to be submited if there is time to report |
| R | Acknowledgment Form (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Social Security Form (SSA-1945) (PDF) | DRB | To be submitted by Admin Staff directly to Division of Retirement and Benefits P.O. Box 110203 Juneau, AK 99811-0203 Fax: 907-465-3086 Email: doa.drb.audit@alaska.gov |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for anyone wishing to receive direct deposit |
| ER | APOC Filing Information (PDF) | APOC | Boards & Commission members are required to file a financial disclosure with Alaska Public Offices Commission (APOC); this can be done online directly. Disclosures must be filed within 30 days of appointment. |
| ER | Supplemental Annuity Plan Beneficiary Designation | Empower | The Boards & Commission members will need to create an account with Empower in order to fill out their Beneficiary Designation information online. Members must wait until after their first payroll has been processed by DRB before setting up an account. Members will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Appointment - Boards & Commissions (TRAVEL ONLY)
The following forms need to be submitted for new Boards & Commissions appointments / hires who DO NOT receive a stipend for attendance, but are required to travel as part of their duties.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a Public Official Financial Disclosure (POFD) within 30 days of appointment. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| ER | APOC Filing Information (PDF) | APOC | Boards & Commission members are required to file a financial disclosure with Alaska Public Offices Commission (APOC); this can be done online directly. Disclosures must be filed within 30 days of appointment. |
Appointment Exempt / Partially Exempt
The following forms need to be filled out for a new hire into an exempt or partially exempt position.
For additional information about insurance enrollment, retirement information, and forms to be submitted please go through the New Employee Orientation.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a Public Official Financial Disclosure (POFD) within 30 days of appointment. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| RP | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | |
| RP | Hire Approval / Governor's Approval Memo for Range 18+ |
DOP-Payroll | Governor's approval memo only required for position in range 18 or higher |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Emergency Contact (PDF) | DOP-Payroll | |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Equal Employment Opportunity Survey (PDF) | DOP-Payroll | |
| R | Pre-Employment Certification (PDF) | DOP-Payroll | |
| R | Social Security Form (SSA-1945) (PDF) | DRB | To be submitted by Admin Staff directly to Division of Retirement and Benefits P.O. Box 110203 Juneau, AK 99811-0203 Fax: 907-465-3086 Email: doa.drb.audit@alaska.gov |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Alaska Police Standards Council F-4 Personnel Action | APSC | Required only for positions requiring APSC Certification |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for anyone wishing to receive their payroll via direct deposit |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| IA | State of Alaska Prior Service Verification (PDF) | DOP-Payroll | Required for hires who previously worked in a permanent full-time, permanent part-time, or long-term nonpermannent (leave accruing) position for the State of Alaska. |
| ER | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER | Health Insurance Enrollment (AlaskaCare) | DRB | Required to apply for Health Insurance Online through DRB's website within 30 days of appointment. |
| ER | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / IA | APOC Filing Information (PDF) | APOC | Required for positions required to submit Alaska Public Offices Commission (APOC) disclosures. Disclosures must be submitted within 30 days of appointment. |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
| ER / IA | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Required for hires currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Appointment Long Term Non Perm
The following forms / documents should be filled out for a new hire into a Long Term Non Perm positon.
For additional information about insurance enrollment, retirement information, and forms to be submitted please go through the New Employee Orientation.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Application with MQ Supporting Documents Only | DOP-Payroll | Example MQ support: transcript; The application and attachments may be submitted separately by the Department Recruitment staff. This sometimes occurs just as a cc to Payroll Services on the hire approval email. Please work with recruitment staff if you have questions regarding this requirement. |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| RP | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Emergency Contact (PDF) | DOP-Payroll | |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Equal Employment Opportunity Survey (PDF) | DOP-Payroll | |
| R | Hire Approval | DOP-Payroll | |
| R | New Employee Appointment Form | DOP-Payroll | This form should be provided by Agency HR Staff |
| R | Pre-Employment Certification (PDF) | DOP-Payroll | |
| R | Social Security Form (SSA-1945) (PDF) | DRB | To be submitted by Admin Staff directly to Division of Retirement and Benefits P.O. Box 110203 Juneau, AK 99811-0203 Fax: 907-465-3086 Email: doa.drb.audit@alaska.gov |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Alaska Police Standards Council F-4 Personnel Action | APSC | Required only for positions requiring APSC Certification |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for SU employees and anyone wishing to receive their payroll via direct deposit |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| IA | State of Alaska Prior Service Verification (PDF) | DOP-Payroll | Required for hires who previously worked in a permanent full-time, permanent part-time, or long-term nonpermannent (leave accruing) position for the State of Alaska. |
| ER | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification |
DRB / Union | Enroll in AlaskaCare or a Health Trust depending on your bargaining unit. Must be completed within 30 days of appointment. |
| ER | Supplemental Annuity Plan Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER | Union Notification Information (PDF) / Union Notification for ASEA (GGU) (PDF) |
Union | Required to notify Union for information regarding membership and dues. It is suggested to contact the Union within 10 days of date of hire. |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Appointment Probationary / Permanent
The following forms are to be filled out for new hires into permanent or probationary status. This does not include new hires into an exempt or partially exempt position, there is a separate packet for these employees.
For additional information about insurance enrollment, retirement information, and forms to be submitted please go through the New Employee Orientation.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Application with MQ Supporting Documents Only | DOP-Payroll | Example MQ support: transcript; The application and attachments may be submitted separately by the Department Recruitment staff. This sometimes occurs just as a cc to Payroll Services on the hire approval email. Please work with recruitment staff if you have questions regarding this requirement. |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| RP | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Emergency Contact (PDF) | DOP-Payroll | |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Equal Employment Opportunity Survey (PDF) | DOP-Payroll | |
| R | Hire Approval | DOP-Payroll | |
| R | New Employee Appointment Form | DOP-Payroll | This form should be provided by Agency HR Staff |
| R | Pre-Employment Certification (PDF) | DOP-Payroll | |
| R | Social Security Form (SSA-1945) (PDF) | DRB | To be submitted by Admin Staff directly to Division of Retirement and Benefits P.O. Box 110203 Juneau, AK 99811-0203 Fax: 907-465-3086 Email: doa.drb.audit@alaska.gov |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Advanced Step Placement Worksheet - Analysis (DOC) | DOP-Payroll | Required when requesting an advanced step placement for a hire |
| IA | Alaska Police Standards Council F-4 Personnel Action | APSC | Required only for positions requiring APSC Certification |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for SU employees and anyone wishing to receive their payroll via direct deposit |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| IA | State of Alaska Prior Service Verification (PDF) | DOP-Payroll | Required for hires who previously worked in a permanent full-time, permanent part-time, or long-term nonpermannent (leave accruing) position for the State of Alaska. |
| ER | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification | DRB / Union | Enroll in AlaskaCare or a Health Trust depending on your bargaining unit. Must be completed within 30 days of appointment. |
| ER | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER | Union Notification Information (PDF) / Union Notification for ASEA (GGU) (PDF) |
Union | Required to notify Union for information regarding membership and dues. It is suggested to contact the Union within 10 days of date of hire. |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
| ER / IA | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Required for hires currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Appointment Short Term / On Call
The following forms are to be filled out for new hires into short term or on call positions.
For additional information about insurance enrollment, retirement information, and forms to be submitted please go through the New Employee Orientation.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Address Authorization / Change Form (PDF) | DOP-Payroll | |
| RP | Application with MQ Supporting Documents Only | DOP-Payroll | Example MQ support: transcript; The application and attachments may be submitted separately by the Department Recruitment staff. This sometimes occurs just as a cc to Payroll Services on the hire approval email. Please work with recruitment staff if you have questions regarding this requirement. |
| RP | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | |
| RP | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Emergency Contact (PDF) | DOP-Payroll | |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Equal Employment Opportunity Survey (PDF) | DOP-Payroll | |
| R | Hire Approval | DOP-Payroll | |
| R | New Employee Appointment Form | DOP-Payroll | This form should be provided by Agency HR Staff |
| R | Pre-Employment Certification (PDF) | DOP-Payroll | |
| R | Social Security Form (SSA-1945) (PDF) | DRB | To be submitted by Admin Staff directly to Division of Retirement and Benefits P.O. Box 110203 Juneau, AK 99811-0203 Fax: 907-465-3086 Email: doa.drb.audit@alaska.gov |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Alaska Police Standards Council F-4 Personnel Action | APSC | Required only for positions requiring APSC Certification |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for SU employees and anyone wishing to receive their payroll via direct deposit |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| ER | Supplemental Annuity Plan Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. Employees must wait until after their first payroll has been processed by DRB before setting up an account. Employees will receive a welcome flyer/postcard from Empower Retirement letting them know that their account is set up. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER | Union Notification Information (PDF) / Union Notification for ASEA (GGU) (PDF) |
Union | Required to notify Union for information regarding membership and dues. It is suggested to contact the Union within 10 days of date of hire. |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
Military Leave (Return From)
The following forms are to be filled out for current state employees returning from Military Leave.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Paper Timesheet | DOP-Payroll | Check with timekeeper for schedule and due date of timesheet. |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required if employee needs to update Direct Deposit |
| IA | Emergency Contact (PDF) | DOP-Payroll | Required if employees emergency contact information needs to be updated |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| O | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll |
Military Leave (To)
The following forms are to be filled out for current state employees going to Military Leave.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Copy of Military Orders | DOP-Payroll | |
| RP | Military Leave Benefit Election Form (PDF) | DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Paper Timesheet | DOP-Payroll | Check with timekeeper for schedule and due date of timesheet. |
| R | Employment Clearance Form (PDF) | DOP-Payroll | |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| O | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll |
Separation / Layoff
The following forms are to be filled out for employees separating from state employment.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a final Public Official Financial Disclosure (POFD) within 90 days of leaving state service. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Final Paper Timesheet | DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| R | Employment Clearance Form (PDF) | DOP-Payroll | |
| R | Performance Evaluation | Department | Supervisor should prepare final evaluation and submit to Division Approver |
| R | Position Resignation Notice | DOP-Payroll | If resignation notice is unavailable please include a note explaining why. |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Dismissal or Notice of Administrative Separation | DOP-Payroll | Required in cases of dismissal or administrative separation |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |
| ER | DRB Leaving State Employment Information | DRB | |
| ER / IA | APOC Filing Information (PDF) | APOC | Required for exempt and partially exempt positions that are required to submit Alaska Public Offices Commission (APOC) disclosures. Disclosures must be submitted within 90 days of separation. |
| ER / IA | COBRA Health Continuation Information for AlaskaCare | DRB | Information for employees currently on AlaskaCare |
| ER / IA | Conditions of Employment Upon Return From Layoff for SU and GGU Employees (DOCX) | DOP-Recruitment | Submit to DOPLR Recruitment Services for GGU and SU Employees in Layoff. The form should be provided at time of Layoff Notification. |
| ER / IA | DPS State Trooper Exit Survey (Required for Separating Troopers Only) | DPS | |
| ER / IA | Health Trust Notification | Union | Required to notify health trust of separation. |
| ER / IA | Layoff Information Sheet: GGU (PDF) / KK (PDF) / LTC (PDF) / SU (PDF) | Employee | Information sheets for Layoff employees in GGU, KK, LTC, and SU bargaining unit |
| ER / IA | Separating Employee Health Insurance Notice (PDF) | Employee | Notification required to be given to separating employees currently covered under Health Insurance. |
| ER / IA | TRS Claim and Verification of Unused Sick Leave Credit (PDF) | DRB | For TRS retirement plan employees, if retiring with unused sick leave |
| ER / O | Exit Survey | DOP-Payroll | The Exit Survey can be filled out online or a paper copy can be faxed or mailed directly to the Division of Personnel |
| ER / O | Supplemental Annuity Withdrawal Request | Empower | The employee will need to create/have an account with Empower in order to fill out the most up to date Supplemental Annuity Withdrawal Request form. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Terminal Leave Payoff Tax Option Form (PDF) | DOP-Payroll |
Separation Boards & Commissions
The following forms are to be filled out for boards and commissions members leaving state service.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a final Public Official Financial Disclosure (POFD) within 90 days of leaving state service. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Final Attendance Sheet | DOP-Payroll | Only required for Boards & Commissions members who received a STIPEND for meeting attendance. |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if address needs to be updated |
| ER / IA | APOC Filing Information (PDF) | APOC | Required for positions required to submit Alaska Public Offices Commission (APOC) disclosures. Disclosures must be submitted within 90 days of separation. |
| ER / O | Supplemental Annuity Withdrawal Request | Empower | The employee will need to create/have an account with Empower in order to fill out the most up to date Supplemental Annuity Withdrawal Request form. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Separation Short Term and On Call
The following forms are to be filled out for Short Term and On Call employees separating from state employment.
Reminder: In accordance with AS 39.50.020, members of certain boards and commissions and other “public officials” as defined under AS 39.50.200 are required to file a final Public Official Financial Disclosure (POFD) within 90 days of leaving state service. (For additional questions please contact the Alaska Public Offices Commission)
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Final Paper Timesheet | DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| R | Employment Clearance Form (PDF) | DOP-Payroll | |
| R | Performance Evaluation | Department | Supervisor should prepare final evaluation and submit to Division Approver |
| R | Position Resignation Notice | DOP-Payroll | If resignation notice is unavailable please include a note explaining why. |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Dismissal or Notice of Administrative Separation | DOP-Payroll | Required in cases of dismissal or administrative separation |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |
| ER | DRB Leaving State Employment Information | DRB | |
| ER / O | Exit Survey | DOP-Payroll | The Exit Survey can be filled out online or a paper copy can be faxed or mailed directly to the Division of Personnel |
| ER / O | Supplemental Annuity Withdrawal Request | Empower | The employee will need to create/have an account with Empower in order to fill out the most up to date Supplemental Annuity Withdrawal Request form. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Seasonal Leave without Pay (Return From)
The following forms are to be filled out for employees returning from seasonal leave without pay.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | GGU Seasonal OT/Comp Time Option Form (PDF) | DOP-Payroll | Required for all GGU employees |
| RP / IA | Paper Timesheet | DOP-Payroll | Check with timekeeper for schedule and due date of timesheet. |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required if employee needs to update Direct Deposit |
| IA | Emergency Contact (PDF) | DOP-Payroll | Required if employees emergency contact information needs to be updated |
| ER | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification |
DRB / Union | Enroll in AlaskaCare or a Health Trust depending on your bargaining unit. Must be completed within 30 days of appointment. |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| O | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll |
Seasonal Leave without Pay (To)
The following forms are to be filled out for employees going to seasonal leave without pay.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Final Paper Timesheet | DOP-Payroll | |
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| RP | Seasonal Employee Leave Retention Form GGU/LTC/SU (PDF) | DOP-Payroll | |
| R | Employment Clearance Form (PDF) | DOP-Payroll | |
| R | Performance Evaluation | Department | Supervisor should prepare final evaluation and submit to Division Approver |
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |
| ER | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification |
DRB / Union | Notify Health Trust or DRB about going on seasonal leave. |
| ER | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll |
Status Change (Name / Marriage / Divorce / Birth)
The following forms are forms for employees who recently went through a status change. Most of these forms are optional or depend on the type of change.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required if employee needs to update Direct Deposit |
| IA | Emergency Contact (PDF) | DOP-Payroll | Required if employees emergency contact information needs to be updated |
| IA | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | Required for name change only; To be submitted by Department Admin Staff |
| IA | Proof of Status Change (Marriage Certificate / Divorce Decree / Birth Certificate) | DOP-Payroll | |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification | DRB / Union | Enroll in AlaskaCare or a Health Trust depending on your bargaining unit. Must be completed within 30 days of status change. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| O | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| O | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll |
Transfer (Separation / Appointment)
A Transfer (Separation / Appointment) packet is required when a current employee transfers from / to the following position combinations:
- Non permanent to Non permanent
- Non permanent to Permanent / Probationary
- Classified to Exempt
- Exempt to Classified
- Exempt to Exempt
- Partially Exempt to Exempt
- Exempt to Partially Exempt
Please note that some forms might be repeated from when the employee was initially hired, but this is necessary due to required record retention maintenance.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel |
DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Application with MQ Supporting Documents Only | DOP-Payroll | Required when employee applied for the position. Example MQ support: transcript; The application and attachments may be submitted separately by the Department Recruitment staff. This sometimes occurs just as a cc to Payroll Services on the hire approval email. Please work with recruitment staff if you have questions regarding this requirement. |
| RP / IA | Employment Eligibility Verification (I-9) (PDF) with copy of License / ID / Passport |
DOP-Payroll | Required when transferring (from/to) Classified or Partially Exempt (to/from) Exempt Position |
| RP / IA | Hire Approval / Governor's Approval Memo for Range 18+ | DOP-Payroll | Required when employee applied for the position; Governor's memo only required for EX or PX position in range 18 or higher |
| RP / IA | Timesheet | DOP-Payroll | Paper timesheet is required if transferring from a different Department. Check with Timekeeper on schedule and due date of Timesheet. |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Current Employee / Position Change Appointment Form | DOP-Payroll | This form should be provided by Agency HR Staff |
| R | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll | |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employee's address needs to be updated. |
| IA | Advanced Step Placement Worksheet - Analysis (DOC) | DOP-Payroll | Required when requesting an advanced step placement for a hire |
| IA | Direct Deposit Authorization (PDF) | DOP-Payroll | Required for SU employees and anyone wishing to receive their payroll via direct deposit |
| IA | Employee Withholding Allowance (W-4) (PDF) | DOP-Payroll | Required if employee wants to update their witholding allowance. |
| IA | Emergency Contact (PDF) | DOP-Payroll | Required if employee's emoergency contact information needs to be updated. |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| IA | Pre-Employment Certification (PDF) | DOP-Payroll | Required when employee applied for the position |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
| ER / IA | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification | DRB / Union | Required to Enroll in AlaskaCare or a Health Trust depending on your bargaining unit when changing between AlaskaCare and Health Trust coverage. Must be completed within 30 days of appointment. |
| ER / IA | Union Notification Information (PDF) / Union Notification for ASEA (GGU) (PDF) | Union | Required to notify the union if moving to a different bargaining unit for information on membership and dues. It is suggested to contact the Union within 10 days of position change. |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create/have an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
Transfer In (Promotion, Demotion, Transfer)
The following forms are for current state employees who move to a new position and to be filled out for the position they are transfering in to. The specific Personnel Action are defined as:
- Transfer - move to a position in the same range
- Promotion - move to a position in a higher range
- Demotion - move to a position in a lower range
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Application with MQ Supporting Documents Only | DOP-Payroll | Required when employee applied for the position. Example MQ support: transcript; The application and attachments may be submitted separately by the Department Recruitment staff. This sometimes occurs just as a cc to Payroll Services on the hire approval email. Please work with recruitment staff if you have questions regarding this requirement. |
| RP / IA | Timesheet | DOP-Payroll | Paper timesheet is required if transferring from a different Department. Check with Timekeeper on schedule and due date of Timesheet. |
| RP / IA | Hire Approval / Governor's Approval Memo for Range 18+ |
DOP-Payroll | Required when employee applied for the position. Governor's memo only required for exempt or partially exempt position in range 18 or higher. |
| R | Alcohol and Drug Free Workplace Act (PDF) | DOP-Payroll | |
| R | Confidentiality of Information Acknowledgement (PDF) | DOP-Payroll | |
| R | Current Employee / Position Change Appointment Form | DOP-Payroll | This form should be provided by Agency HR Staff |
| R | Employee Affidavit Oath of Office (PDF) | DOP-Payroll | |
| R | Statewide Policy Acknowledgement Form (PDF) | DOP-Payroll |
|
| IA | Address Authorization / Change Form (PDF) | DOP-Payroll | Required if employees address needs to be updated |
| IA | Emergency Contact (PDF) | DOP-Payroll | Required if employees emergency contact information needs to be updated |
| IA | Firearm Certification New Hire (PDF) | DOP-Payroll | Required for positions permitted or required to possess or use firearms |
| IA | Nepotism Waiver (PDF) | DOP-Payroll | Required for any hire who has a familial relationship with a current employee. Please review the Nepotism FAQ (PDF). |
| IA | Pre-Employment Certification (PDF) | DOP-Payroll | Required when employee applied for the position. |
| IA | State Trooper Transfer Letter / Memo | DOP-Payroll | Required for transfer, but not administrative PCN changes; State Troopers Only. |
| ER / IA | Ethics Disclosure: Outside Employment or Services (PDF) | Department | Required to be submitted to Department's Designated Ethics Supervisor |
| ER / IA | Health Insurance Enrollment (AlaskaCare) / Health Trust Notification | DRB / Union | Required to Enroll in AlaskaCare or a Health Trust depending on your bargaining unit when changing between AlaskaCare and Health Trust coverage. Must be completed within 30 days of appointment. |
| ER / IA | Union Notification Information (PDF) / Union Notification for ASEA (GGU) (PDF) | Union | Required to notify the union if moving to a different bargaining unit for information on membership and dues. It is suggested to contact the Union within 10 days of position change. |
| ER / O | Basic / Select / Voluntary Supplemental Life and AD&D Insurance Forms | Benefitfocus | To enroll in all life insurance options employees will need to create or have an account with Benefitfocus. Due within 30 days of appointment; Select Life and AD&D and Voluntary Supplemental Life and AD&D are optional benefits. If you cannot enroll online or have any questions please contact State of Alaska Voluntary Benefits Support Toll-free: 844.939.0543 or by Email: SOABenefits@benefitfocus.com. |
| ER / O | Deferred Compensation Plan Forms | Empower | The employee will need to create an account with Empower in order to fill out their Deferred Compensation Plan information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| ER / O | PERS Tier I, II, III / TRS I, II Defined Benefit Beneficiary Designation(PDF) | DRB | Option for employees currently in PERS Tier I, II, III / TRS I, II retirement plan |
| ER / O | Supplemental Annuity Plan / PERS Tier IV / TRS Tier III Beneficiary Designation | Empower | The employee will need to create or have an account with Empower in order to fill out their Beneficiary Designation information online. If you cannot fill out the forms online please contact Empower Retirement at (800)232-0859 or find more information about Empower Retirement Services on DRB's website. |
| O | Designation of Beneficiary for Unpaid Compensation (PDF) | DOP-Payroll |
Transfer Out
The following forms are for current state employees moving to a new position. These are required when leaving their current position.
| Req. | Form / Document | Submit To | Additional Instructions |
|---|---|---|---|
| RP | Personnel Action Request Form (PARF) PDF/Excel | DOP-Payroll | To be submitted by Department Admin Staff |
| RP / IA | Final Paper Timesheet | DOP-Payroll | Required if transferring to a different department. Paper timesheet must be submitted. |
| R | Employment Clearance Form (PDF) | DOP-Payroll | |
| R | Performance Evaluation | Department | Supervisor should prepare final evaluation and submit to Division Approver |
| R | Position Resignation Notice | DOP-Payroll | If resignation notice is unavailable please include a note explaining why. |
| IA | HSS Federal Program Employee Certification Form | HSS | Required for HSS employees leaving positions that are federally funded. Please talk to your administrative manager for the latest copy of the form. |