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

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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 2024 Excellus Medicare Supplemental Application

Medicare Supplement Plan G Information

Medicare 2024 Simply P (Prescriptions) Application

Medicare 2024 Simply P (Prescriptions)  Information

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

Optional Coverages Information

Paid Time Off (PTO) Request

Retirement Registration Form

Stetson Club Buy Out Form

W4 – 2023

Workers Compensation C-2F