City of Traverse City
Employee Forms

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Miscellaneous Forms:

• Authorization for Automatic Deposit

• Educational Incentive Plan Request Form

• FSA Medical Care Expense Claim Form

• FSA Dependent Care Claim Form

• FSA Election Form & Salary Redirection Agreement

• Hartford 457 Deferred Comp Change Form

• Hartford 457 Def Comp Investment Election Change/Transfer Form  Your current and future allocations may be changed online at Hartford

• ICMA 457 Deferred Comp Change Form  Your current and future allocations may be changed online at ICMA

• Injury Report & Medical Authorization

• MERS Name/Address Change (Muunicipal Employees' Retirement System)

• W-4  Michigan Withholding Allowance Form

• W-4  Federal Withholding Allowance Form

Insurance Change Forms:

• Priority Health

• Blue Cross/Blue Shield

• Delta Dental Update form

• Opt Out of Insurance Form (must be completed each June if you wish to continue to opt out of insurance.)

Employee Information:

• Employee Assistance Program

• Organizational Chart

Employee Home Page