{"id":215,"date":"2014-08-04T15:26:01","date_gmt":"2014-08-04T22:26:01","guid":{"rendered":"http:\/\/www.graniteschools.org\/hr\/?page_id=215"},"modified":"2026-06-17T15:03:07","modified_gmt":"2026-06-17T21:03:07","slug":"benefit-forms","status":"publish","type":"page","link":"https:\/\/www.graniteschools.org\/hr\/benefits\/benefit-forms\/","title":{"rendered":"Leave Forms &amp; Documents"},"content":{"rendered":"<div class=\"wp-block-image\">\n<figure class=\"alignright\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"164\" data-attachment-id=\"315\" data-permalink=\"https:\/\/www.graniteschools.org\/hr\/benefits\/benefit-forms\/page6_2\/\" data-orig-file=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/page6_2.jpg\" data-orig-size=\"530,291\" data-comments-opened=\"0\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;}\" data-image-title=\"books with book guy\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/page6_2.jpg\" src=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/page6_2-300x164.jpg\" alt=\"image of open books stacked together\" class=\"wp-image-315\" srcset=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/page6_2-300x164.jpg 300w, https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/page6_2.jpg 530w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\">GSD employee&#8217;s must always be on an approved leave. Listed below in alphabetical order are the necessary forms an employee may need for a leave option. Please complete the necessary forms and return to the benefits office.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Beneficiary Change Form<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Beneficiary is the person\/persons you want to leave any life insurance or other financial payouts too in the unlikely event of your death. Use this form to make changes to your beneficiary.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/05\/Beneficiary-Change-Form-Updated.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Beneficiary Change Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Contract Employee 15 Day Leave Form<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Use this form when you have no other leave options are available.  The 15-Day leave is all w\/o pay.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1DJBQD2wT3ChVbzM95fY6xE1moWND1EXJ\/view?usp=sharing\">Contract Employee 15 Day Leave Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">COVID-19 Respiratory Virus Guidelines  <\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Granite School District follows the CDC guidelines for COVID-19 and respiratory viruses.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Employees will follow district policy and procedures for sick leave and use their accrued leave.  If accrued leave is not available contact the benefit department for available leave options.<\/p>\n\n\n<ul>\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/03\/New-CDC-Respiratory-Viruse-Guidelines-2024.pdf\">New CDC Covid-19 Respiratory Virus Guidelines 2024 (PDF)<\/a><\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/respiratory-viruses\/prevention\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Frespiratory-viruses%2Fguidance%2Findex.html\">CDC Respiratory Virus Information Webpage<\/a><\/li>\n<\/ul>\n\n\n<h3 class=\"wp-block-heading\">Granite Medical Leave Form (GMLF)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Use this form if you are gone for more than 3 consecutive days for sick leave. Anytime you have surgery or have other medical related issues you will need the GMLF form prior to leaving, and prior to returning. The GMLF form is required releasing you back to work. The GMLF form is also required as part of the short term disability leave.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/10dcxcVkg5MR21CzaX2vMw-3k808zn4rS\/view?usp=sharing\">Granite Medical Leave Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Family Medical Leave Act (FMLA)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Eligible employees can take up to 12 work weeks of unpaid leave during any 12-month period to attend to the serious health condition of the employee, parent, spouse or child, or for pregnancy or care of a newborn child, or for adoption or foster care of a child. In order to be eligible for FMLA leave, an employee must have been employed at least 12 months, and worked at least 1,200 hours over the past 12 months.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1gOP3iqkMMMS-Bwam8NFzSNrX0dtMR06J\/view?usp=drive_link\" target=\"_blank\" rel=\"noreferrer noopener\">FMLA Application (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/05\/FMLA-Employee-Certification-of-Health-Care-Provider-2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">FMLA Employee Certificate of Health Care Provider (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/177Ed7VsuKjMo-bp9gkkecmqpSQtqR3iQ\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">FMLA Family Certificate of Health Care Provider (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/08\/fmlaen.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">FMLA Employee Rights (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Flexible Spending Reimbursement<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Use the form when you need to submit receipts for your Flexible Spending Account(FSA).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2014\/08\/FSA-Claim-Reimbursement-Form.pdf\">FSA Claim Reimbursement Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Hourly Employee 15 Day Leave Form<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This form is only used for hourly employees who are not eligible for other leave options.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1p9mJX8uKmX2DiR5t36FWEMxQvVkVmlIM\/view?usp=drive_link\">Hourly Employee 15 Day Leave Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Life Status Change Form<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Anytime you have a life changing event for example: marriage, death, divorce, birth of child, adoption, loss of benefit coverage, FTE status change. You have 30 days from the date of the qualifying event to make changes to your benefit insurance. This form is what you will complete and turn into the benefits office along with proper documentation of life event.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1CrSrYf-ssEVtZcF54WdtuslvJcfFh0By\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">Life Status Change Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Life Insurance <\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Evidence Of Insurability (EOI)<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If you make an election\/change to increase your life insurance above or after your guaranteed issued opportunity. You will need to complete the EOI form which is a health questionnaire. Your benefit election\/change will only be affective once your EOI is approved by the carrier.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2021\/03\/2020-Lincoln-Voluntary-Life-EOI-Form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Lincoln Voluntary Life EOI Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Termination Continuation Forms<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Employees are able to continue life insurance coverage when they terminate. Employees have 30 days from the date of termination to convert their group life insurance policy into their own private policy. There are two ways this can be done. 1) Conversation &#8211; This form is used to convert your group life insurance into your own personal policy. New rates would apply. 2) Portability &#8211; This form is used to convert your group life insurance into your own personal policy and maintain the rates you are currently paying. If the District ever changed life insurance carrier you would lose your portability coverage.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>Please contact benefit office for forms, benefits@graniteschools.org, 383-646-4528<\/em><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Long Term Disability Claim&nbsp; Forms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">If you are applying for Long Term Disability.&nbsp; Please select the link matching your position class.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2019\/02\/Granite-School-District-Summary-LTD-Class-1.pdf\">Admin\\Middle Managers LTD Claim Information (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2019\/02\/Granite-School-District-Summary-LTD-Class-2.pdf\">Classified\\Secretaries LTD Claim Information (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2019\/02\/Granite-School-District-Summary-Contrib-LTD-Class-3.pdf\">Teachers LTD Claim Information (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Maternity<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Maternity leave needs vary by employee. Under the new Parental Leave law, eligible employees may take up to six weeks of paid leave three weeks of postpartum leave and three weeks of parental leave. A working spouse may also qualify for up to three weeks of paid parental leave. For additional information, please contact the Benefits Office at 385-646-4528.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1cwt9_enoGYxTc8O42SF0fd5S_ykN2ymt\/view?usp=sharing\">Maternity Leave Flyer (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1YK4J9Nvr8ZhvAUQ_GYWYwmnjQtk7orjT\/view?usp=sharing\">GSD Parent Leave Policy (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">MetLife <em>(Accident, Hospital, Critical Illness<\/em>) Claim&nbsp;Form<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Listed below are the forms you will need to file your voluntary claims with MetLife.<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2022\/07\/AH-How-to-File-a-Claim.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">MetLife How To File A Claim (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Physician Form (Wellness)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Employees are to use this form to show they have completed their annual physical or biometric screening.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/193Wgjn7QxKKsJMzO_eNfNhoqKB75APTv\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">2026 Physician Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Short Term Disability (STD)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Eligible employees can take up to 120 calendar days earning 80% of their daily rate. STD can only be used for employees own health condition. For more information on STD leave and eligibility please click here.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/08\/Short-Term-Claim-Form-fillable.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Short Term Disability Claim Forms (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.graniteschools.org\/hr\/wp-content\/uploads\/sites\/19\/2024\/08\/STD-Memorandum.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Short Term Disability Memorandum (PDF)<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>GSD employee&#8217;s must always be on an approved leave. Listed below in alphabetical order are the necessary forms an employee may need for a leave option. Please complete the necessary forms and return to the benefits office. Beneficiary Change Form Beneficiary is the person\/persons you want to leave any life insurance or other financial payouts [&hellip;]<\/p>\n","protected":false},"author":28,"featured_media":0,"parent":46,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","_gsd_hide_title":false,"footnotes":""},"class_list":["post-215","page","type-page","status-publish","entry","has-post-thumbnail"],"featured_image_src":null,"featured_image_src_square":null,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/pages\/215","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/comments?post=215"}],"version-history":[{"count":10,"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/pages\/215\/revisions"}],"predecessor-version":[{"id":4217,"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/pages\/215\/revisions\/4217"}],"up":[{"embeddable":true,"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/www.graniteschools.org\/hr\/wp-json\/wp\/v2\/media?parent=215"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}