Human Resources Forms

Employment Applications

Recruitment and Selection is no longer accepting paper applications.  Go to the Recruitment & Selection link of Human Resources, select the appropriate link to our Career Centers to apply for any open Pima County position.

• ADA Job Applicant Request for Accommodations
• Request for Preference Points
• Personnel Action Form
• Personnel Action Form Instructions 
• Department Information
• Action and Action Reason Dropdown List 

Classification and Compensation

• Reallocation Request Form  
• Vacant Reallocation Request Form for AP 23-48  
• Pima County Multilingual Use Audit Worksheet for AP 3-34
• Multilingual Proficiency Examination Request Form for  AP 3-34
• Salary Study Request Form AP 23-27

For classification and compensation details for each position, please visit our classification and compensation page.

Benefit Forms

Domestic Partner Forms

• Domestic Partner Affidavit (for insurance related purposes, as well as use of sick leave and humanitarian leave)
• Domestic Partner Termination Form

Note: Domestic Partner is covered under Pima County's Insurance Plan.

Employee Assistance Program (EAP) Forms

• Mandatory Management Referral Form / Authorization to Release of Information – EAP 
• Confirmation of Attendance for Management Referrals 

Medical / Pharmacy / Dental / Vision Claim Forms

• Medical Claim Form
• Aetna Member Complaint and Appeal Form
• Aetna Member Prescription Drug Claim Form
• CVS /Caremark Claim Reimbursement Form
• Pima County Dental Out of Country Claim Form
• Vision Claim Form

Health Savings Account (HSA) Forms

• HSA Bank Claims Reversal Form

Flexible Spending Account (FSA) Forms

• Section 125 - Flexible Spending Account - Claim Form 
• Section 125 and 132 - Direct Deposit Form 
• Section 132 - Pre-Tax Parking and Transit - Claim Form 

Supplemental Retirement Forms

• 401(a) Beneficiary Form

E-Verify®

• I-9 Form
• I-9 Lists of Acceptable Documents
• NEOGOV E-verify Training Manual

Family and Medical Leave Act (FMLA)

• Leave Administration Form
• Pima County Family and Medical Leave (FMLA) Certification
• Fitness for Duty Report
• Parental Leave Request Form
• Request for Paid Short Term Disability Form
• Workers Compensation Request

 

Employment Rights

Americans with Disabilities Act (ADA) Forms

• ADA Job Applicant Request for Accommodations
• ADA Employee Self-Referral
• ADA Department Referral  
• ADA Application for Disabled Parking Permit  

Appeal Forms

• Merit System Appeal (Merit System Rule 14)
• Law Enforcement Merit System Appeal (Law Enforcement Merit System Rule XIII-4) *

Grievance Forms

• Grievance Not Alleging Discrimination (Merit System Rule 13.2)
• Grievance Alleging Discrimination (Merit System Rule 13.3)
• Discrimination Grievance - For Unclassified Employees (BOS Policy D 21.3) 
• Law Enforcement - Grievance Not Alleging Discrimination (Law Enforcement Merit System Rule XIII-2) *
• Law Enforcement - Grievance Alleging Discrimination (Law Enforcement Merit System Rule XIII-3) *

* These forms are to be used only by Law Enforcement Officers of the Sheriff's Department.

Individualized Training Plans

• Individualized Training Plan Blank Form

Investigation of Unpaid Wages

• Request for Wage Adjustment Form

Mediation Forms

• Request for Mediation - Prior To Filing A Grievance
• Request for Mediation - Not Involving A Grievance
• Supervisor Referral For Mediation

Outside Employment

• Outside Employment Form

Neo Gov

• NeoGov Access Form
• NeoGov HR Liaison (DPR) and SME Training Dates