PEO Forms

We have put these links together to provide you with some useful forms for Northern Nevada PEO employers. The following PDF forms are fillable, and you may then save and email the forms as attachments to:

• HR Department Email – humanresources@appliedstaffing.com
• Celeste Peterson – celeste.peterson@appliedstaffing.com
• Megan Lee – megan.lee@appliedstaffing.com
• Mindy Parkkonen – mindy.parkkonen@appliedstaffing.com

• Payroll Department Email – payroll@appliedstaffing.com
• Shari La Fazia – shari.lafazia@appliedstaffing.com

New Insurance Enrollment Packet

Premium Deduction Authorization Form (Required)

Anthem Enrollment Form (Medical)

Best Dental Enrollment Form (Dental)

VSP Enrollment Form (Vision)

New Hire Employment Packet

Generic Employment Application

2008 W-4 Form

I-9 Form

Drug Screen Authorization

Prohibited Harassment Policy

Direct Deposit Authorization Form

Workplace Safety

Employment Forms

Direct Deposit Authorization Form

Notice of Injury or Occupational Disease

Personnel Action Form

Employee Warning Notice

Exit Interview

Additional Benefit Forms

Anthem Insurance Enrollment Form

Section 125 FSA Enrollment Form

Section 125 Reimbursement Form

Section 125 Eligible Expenses

Anthem Medical Summary of Benefits

Best Dental/VSP Summary of Benefits

Best Dental Provider List

V S P Providers List

VSP Enrollment Form

BEST Dental Enrollment Form

Anthem Blue Cross/Blue Shield: www.Anthem.com Phone number: 877-811-3106

Best Dental: www.ddsppo.com Phone number: 800-237-8543

VSP: www.vsp.com Phone number: 800-877-7195

401K Forms

Hartford 401K Enrollment Form

Hartford 401K Beneficiary Enrollment Form

Hartford 401K Change Form

Hartford Loan Request Form

Hartford In-Service Withdrawal Request Form