Benefits and Forms

Medical and Dental Benefits

Benefit Guide and Video

Medical Benefit Summary

Dental Benefit Summary

Vision Benefit Summary

2022VisionServicePlanVSP-EOC.pdf

Benefit Enrollment Form

Benefit Enrollment Forms

SISC Health Resources and Information

Human Resources Forms

Unit Petition Form

Change of Information Form

Change of Information Form* This form must be returned in person to HR Dept.

State and Federal Tax Forms:

W-4 Federal Tax Form 2023* This form must be returned in person to Payroll Dept.
State Tax Form DE-4 *This form must be returned in person to Payroll Dept.

Direct Deposit Form:

Direct Deposit Form*This form must be returned in person to Payroll Dept.

The Evergreen School District seeks to ensure that all its programs operate in compliance with the law. Policies and administrative regulations are provided for parent and community information. Please see Evergreen School District Policies for information on all policies including those involving Non-Discrimination/Harassment, Title IX compliance, and/or Sexual Harassment.

Please contact the Assistant Superintendent of Human Resources if you have questions or desire additional information.

Samuel Bass

Work: (408) 270 - 6816

Work

3188 Quimby Road

San Jose, California 95148

United States of America

In This Section

Benefits and Forms

Medical and Dental Benefits

SISC Health Resources and Information

Human Resources Forms

Compliance Policies

Samuel Bass

Employee Benefit

FMLA And CFRA

Human Resources