Employment Forms

Please email completed forms to Human Resources, hrnewhire@ci.missoula.mt.us

To digitally sign, download, and/or open forms with Adobe PDF Reader. 

• Decedent’s Warrant (PDF)
• Direct Deposit (PDF)
• Employee Records (PDF)
• Federal W-4 (PDF)
• FURS Membership [Fire Only] (PDF)  
• I-9 Acceptable Documentation (PDF)
• Montana W-4 (PDF)
• MPORS Membership [Police Only] (PDF) 
• PERS Membership (PDF)
• PERS Optional Membership (PDF)
• Prior Employment Certification (PDF)
• Social Security Exemption [Police & Fire Only] (PDF)
• Voluntary Self Identification (PDF)

Leave Forms

• Leave Donations (PDF)
• Request for Donated Leave (PDF)
• FMLA Medical Certification (PDF)
• FMLA Request Form (PDF)
• FMLA Return to Work Certification (PDF)
• Pregnancy-Related Medical Leave Form (PDF)
• Authorization to Release Information (PDF)

Benefits Forms

Return Completed Forms to Human Resources

• Benefits at a Glance (PDF)
• Blood Screening Verification (PDF)
• Direct Deposit of Flex Reimbursement (PDF)
• Declaration of Domestic Partnership (PDF)
• Supplemental Vision Enrollment Form (DOC)
• Flexible Benefits Enrollment Form (PDF)
• Joint Processing Form (PDF)
• Request for Health Plan Enrollment Change (PDF)

Return the Following Forms to Allegiance

• Medical Claim Form (PDF)
• Medical Flex Claim Form (PDF)
• Dependent Care FSA Reimbursement Request Form (PDF)
• Daycare Reimbursement Contract (PDF)

Pharmacy Benefit Forms

• Ridgeway Drug Mail Order Form (PDF)
• Costco Mail Order Service: Please contact HR Office for instructions.

Deferred Compensation

Return the Deferred Compensation Plans forms to the Human Resources Office.