Admin

Current Employees


**Below is a list of forms for existing employees. Click links to move directly to a form.  All forms are in Adobe Acrobat (PDF) format.

**Use the "Tab" key to move between fields while completing a form. please complete the form and sign where required prior to mailing or faxing. If you fax the form, please mail the hard copy so that we have your original signature.

Our mailing address is:                      Our fax number is: 203-854-4095

         Norwalk Public Schools
         Attention: HR / Talent Office
         125 East Avenue
         Post Office Box 6001
         Norwalk, CT 06852-6001
Please contact burrd@norwalkps.org 
to report link errors.  Thank you.
 Employee Self Service
 Life, Dental, Vision ESS Qualifying Life Event
AETNA Beneficiary Designation Form  
DELTA DENTAL ENROLLMENT FORM FMLA (Family Medical Leave Act)
Delta Dental Claim Form FMLA for Employee WH-380
IPI Dental Claim Form FMLA for Family Member WH-380
Norwalk BOE - Vision Benefit Summary FMLA Employee Guide 2018
Anthem Claim Form - Vision ONLY FMLA Poster
ANTHEM ENROLLMENT-MEMBER CHANGE FORM
Tax & Payroll FSA (Flexible Spending Account)
Affidavit Federal 1040 Tax Form Dependent Confirmation FSA Plan Description 2018
First Look @ Your First Paycheck
FSA Enrollment Form 2018 
403b / 457 FSA Reimbursement Form 2018
403(b) APPROVED PROVIDERS
2018 UNIVERSAL AVAILABILITY NOTICE Admin/Teacher Evaluations
ANNUAL ELIGIBILITY NOTICE - 2018 NPS Admin Eval Plan & Rubrics 2018-2019
OMNI INSTRUCTIONS NPS Teval Service Providers 2018-2019
Nwk Teval 2018-2019

Health Insurance Information

State 2.0 Brochure REV201807
State 2.0 Partnership Plan
State 2.0 Member Presentation REV201807
State 2.0 Health Discount Program
State 2.0 Oxford Healthy Bonus          State 2.0 Clinical Programs
‚ÄčConnecticut 2.0 Insurance Roll-Out Information HEP Compliance UHC - 10/1/2017 enrollment -Compliance deadline 12/31/2018
Enrollment anytime during 2018 - compliance deadline - 12/31/2019
State 2.0 Enrollment Form State 2.0 HEP Preventive Requirements
Instructions to Print Connecticut 2.0 Cards   CVS Benefits at a Glance REV201807
State 2.0 Member Change Form    CVS Caremark - Prescriptions          
   
Union Contracts Miscellaneous Forms
NASA Contract 2015-2018 Personal Day Request
BOE - NASA Agreement 20170722 Request for school sponsored field trip
NFT Contract 2016-2019 Visiting or Professional Day Request
NFT - BOE Agreement 20170829 Teacher Evaluation Professional Learning Plan
NFT MOA re SPED Case Managers Administrator Request Form July 2018
NFT MOA re Extended Day and Time  
HCE Nurse's Contract 2016-2019 Holiday and Weather Related Closings
ESG Contract 2016 - 2019 School Building/Office Holiday Schedule 2018-2019
UFT Technician's Contract 2016-2019 Weather Related Closings 20181105
UPSEU Contract thru June 30, 2020 Thanksgiving Dismissal Letter 20181105
NFEP Local 1723 2013-2017  
Food Service Contract thru 6-30-2020