Have questions about documents on this page?

Please contact Barbara Krizen at (585)637-5300 x. 111 or at BKrizen@brockportny.org

Employee Handbook 2022

Employee Handbook Receipt Acknowledgement

*****************************************************************************************************************************************************

Bond Benefits – Open Enrollment Kit

Cancer Screening PTO (Breast/Prostate)

COBRA Reference Guide

Direct Deposit Form

Domestic Partnership Registration

Excellus Medical Enrollment Application

Excellus Preventive Drug List (03/2022)

Excellus Telemedicine

Excellus Waiver of Group Coverage

EyeMed Enrollment Form

Harassment Complaint Form

HRA Enrollment Form

IT 2104 – 2023

Medicare 2023 Excellus Medicare Supplemental Application

Medicare Supplement Plan G Information

Medicare 2023 Simply P (Prescriptions) Application

Medicare 2023 Simply P (Prescriptions)  Information

Mutual Of Omaha Enrollment Form (Involuntary Life, Short Term Disability, Dental, Voluntary Life)

Optional Coverages Information

Retirement Registration Form

Stetson Club Buy Out Form

W4 – 2023

Workers Compensation C-2F