Human Resources Forms and Links

 

Human Resources Forms and Links


This page is for the storage of files that may not be accessible according to the Section 508 Accessibility Standards. Port Huron Schools is in the process of re-mediating the files into an accessible format. As the files are made accessible, they will be moved to the main Human Resources page.

While the re-mediation process is occurring, these files are still available to access by this archive page, but please do not link to any files located here as they may be changed/removed at any time.

Please direct any questions about files on this page to webaccessibilitycoordinator@phasd.us

Employee Online

View Paystubs Online

Employee Online Instructions

Employee Online W-2 Instructions

Please contact the Payroll Department with issues regarding your password and questions.

Employee Forms

Name and Address Change Form

Direct Deposit Form

City Tax Form

State Tax Form

Federal Tax Form

Deferred Compensation (409A) Pay Option Election Form

Administrator Forms

Report of Vacancy Form

Additional Pay Timesheet

School Forms

Volunteer Background Check - Fillable

Bloodborne Pathogen Training

Bloodborne Pathogen Training

District PSD History Link

http://intranet.phasd.us/psdhistory/

BENEFITS INFORMATION


MESSA Insurance


The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment

ACA Mandated Summary of Benefits and Coverage for Teachers, Secretaries and Paraprofessionals - ABC Plan 1 (No Coinsurance)

2018 Insurance Cost for Teachers with HSA 
2018 Insurance Cost for Teachers without HSA 

2017-18 Insurance Cost for Secretaries with HSA

2017-18 Insurance Cost for Secretaries without HSA

2017-18 Insurance Cost for Paraprofessionals with HSA
2017-18 Insurance Cost for Paraprofessionals without HSA

MESSA ABC Plan Application
MESSA Member Change Form
MESSA Beneficiary Designation Form

Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists with Health Insurance
Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists without Health Insurance

Long Term Disability Summary of Benefits for Teachers

Life Insurance Summary of Benefits (Optional)
Long Term Disability Summary of Benefits (Optional)
Short Term Disability Summary of Benefits (Optional)
MESSA Optional Insurance Rates

DELTA Dental Summary of Benefits
DELTA Dental 80% Non-Coordination of Benefits Highlights
DELTA Dental 50% Coordination of Benefits Highlights

VSP Vision Summary of Benefits
VSP Vision Plan Highlights

Waiver of Health Insurance for Secretaries and Paraprofessionals

Blue Cross Blue Shield of Michigan
The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment. You can view this by clicking on the link below that pertains to your bargaining unit:

2018 BCBS Insurance Cost

BCBS Member Application

Blue Care Network
The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment. You can view this by clicking on the link below that pertains to your bargaining unit:

2018 BCN Insurance Cost

BCN Member Application

Health Equity

Healthy Equity Website

Health Savings Account Reimbursement Form

Health Savings Account Advancement Request Form

2018 H.S.A. Payroll Deduction Authorization Form

Waiver of District Pre-Funded Contribution to Health Savings Account

Health Savings Account and Flexible Spending Account Information

IRS Publication 502 - Qualified Medical and Dental Expenses

IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans

CIGNA Dental Insurance

CIGNA Dental Enrollment/Change Form

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Coordination of Benefits, Dental Summary of Plan Benefits

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Non-Coordination of Benefits, Dental Summary of Plan Benefits

Teamsters Dental Summary of Plan Benefits

Food Service Dental Summary of Plan Benefits

Paraprofessional Dental Summary of Plan Benefits

Secretary with Health Summary of Plan Benefits

Secretary without Health Summary of Plan Benefits

CIGNA Life Insurance

CIGNA Beneficiary Designation Form


EyeMed Vision Insurance

EyeMed Enrollment/Change Form

Family Medical Leave Act

Employee Rights under FMLA

FMLA Questions and Answers

Federal Mandates

403(B) & 457 Information

403 (b) Plan by MidAmerica

Notice of Universal Availability Eligibility to Contribute to 403 (b) / 457 Plans

403(b) Plan Highlights

403(b) Salary Reduction Agreement

457 Plan Highlights

457 Salary Reduction Agreement

457 Plan Deferred Compensation Option through ORS

Office of Retirement Services (ORS)

Office of Retirement Services Website


ORS Beneficiary Election Form

ORS Name and Address Change Form


Professional Staff Evaluation Packages

2015/2016 Evaluation Information for Each Professional Group

The packets as well as any Forms and Attachments listed have been shared with staff and require a PHASD login to view the files through the links on this page. If you are logged-in to your PHASD account, the documents should automatically open in Google Docs; otherwise, a Google login screen will appear.

Forms and Attachments

PHASD Teacher Evaluation Form 2015-2016
PHASD Teacher Consultant Evaluation Form 2015-2016
PHASD Social Worker Evaluation Form 2015-2016
PHASD SLP Evaluation Form 2015-2016
PHASD School Counselor Evaluation Form 2015-2016
PHASD OT Evaluation Form 2015-2016
PHASD Media Specialist Evaluation Form 2015-2016
PHASD Instructional Coach Evaluation Form 2015-2016
PHASD ESL Teacher/Consultant Evaluation Form 2015-2016
PHASD BIC Evaluation Form 2015-2016