Employee Benefits Documents and Forms

1. Download necessary form(s)
2. Please complete each section of the entire form along with your signature.
3. Submit via email to [email protected]

• Federal Withholding Form (W4) - Federal Tax Withholdings Changes
• State Withholding Form (EDD) – State Tax Withholdings Changes
• Direct Deposit Authorization Form – Direct Deposit Information/Changes
   This online form will be submitted directly to the Controller-Treasurer Department’s
   Payroll Division. For questions, please contact Payroll via email at
   [email protected] or by phone at (408) 299-5200.
• Final Warrant and Next of Kin Form - Name Changes, Address Changes, Emergency
  Contacts, and Final Warrant Beneficiary
• Benefit Enrollment and Change Form (BEN-02) – Benefits Option Plans/Changes
• CalPERS Beneficiary Form - CalPERS Beneficiaries Designation
   Visit http://www.calpers.ca.gov/beneficiary or call (888) 225-7377.