HFM
BOCES uses many different forms for a variety of purposes.
For your convenience, here is a list of
forms currently available for downloading. If you do not see
the form you are looking for here, please contact the
appropriate department. Forms for
employees:
Application for approval of college credits
(pdf - revised Aug. 2012)
2011-12 Conference
request form (PDF revised 8/16/2011)
2011-12 Conference
expense form (PDF updated Aug. 16, 2011) Includes
the July 1, 2011 revised federal mileage reimbursement rate (55.5 cents
per mile)
Note:
New York State Labor Law entitles HFM BOCES employees to take a
leave of absence for breast or prostate cancer screening, and to
donate blood. Please submit the correct form to document your
request.
Blood Donation Leave Request
(pdf)
Cancer Screening Leave
Request
(pdf)
Checklist for Paycheck Accuracy
(pdf) When you receive your first paycheck,
please check the items on this list for accuracy.
Courier Service - Confidential Form
(pdf - Revised 2012)
Employee's report of injury form
(pdf - Revised Aug. 2012))
Facilities Use form (pdf
- revised 2012)
Bouchey & Clarke
Flexible Spending Account - Health Care Reimbursement Claim Form
(pdf)
Bouchey & Clarke
Flexible Spending Account - Dependent Health Care Reimbursement
Claim Form
(pdf)
NEW -
Flexible Spending Account - Health Care Reimbursement Claim Form
(pdf - Effective July 1, 2013)
NEW -
Flexible Spending Account - Dependent Health Care Reimbursement
Claim Form
(pdf - Effective July 1, 2013)
Harassment Complaint form (including sexual harassment)(pdf)
Information regarding workplace harassment may be
found in HFM BOCES Board Policy Manual
here (http://www.moboces.org/districtpolicies/?public=hfmboces)
under Section 0010 EQUAL OPPORTUNITY AND NONDISCRIMINATION.
Health/Safety Concern Reporting Form
(pdf)
IMPORTANT: This form should be used for
circumstances related to specific safety and health issues that
need to be addressed outside of the normal work order system.
Please enter routine comfort-related requests through the work
order system online. Emergency situations should be reported
directly to your program supervisor or the Operations Department
at 736-4380.
Inventory equipment disposal form
(pdf)
Mileage chart
- (PDF - Revised Jan 30, 2013)
The federal mileage reimbursement rate will increase to 56.5 cents per mile, effective
Jan. 1, 2013.
Use these forms to claim reimbursement for miles
accumulated in 2013.
2013 Mileage claim form
- 56.5 cents/mile (Microsoft Excel)
To download the Microsoft Excel worksheet for
your use, right click on the link above and select "Save Target
as..." to save the file to your own computer.
2013 Mileage claim form
- 56.5 cents/mile (PDF)
Per
Hour Payroll form (pdf - Rev. 9/23/11)
Payroll election form
Substitute claim form
(pdf - revised 1/10/2013)
•
Workers' Compensation Pharmacy Benefits
(pdf)
•
Workers' Compensation Temporary Prescription Services ID
(pdf)
Technology Information form (pdf)
Use this form to request computer, e-mail and
network access for new employees or employees who change
position or division
Forms for component school districts:
Cross-contract request form
2012
Facilities Use form (pdf)
HFM BOCES Service Award
2013 Nomination Form
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