2019 Benefit Rates Active Employees

Meritain Enrollment Form

Dental Enrollment Form

Dental Change Form

Met Life Beneficiary Form

Met Life Supplemental Enrollment New Hires Form

Met Life Supplemental Enrollment Form (Only open in November)

Met Life Statement of Health

Nationwide Retirement Solutions Asset Transfer Out Request

Flex Spending Account Form (Only open in November)

Express Scripts Mail Order Form

Active Employee Premier Health Plan

Active Employee Standard Health Plan

Tennessee Consolidated Retirement System (TCRS) Change of Beneficiary Form

Tennessee Consolidated Retirement System (TCRS) Application For Additional Retirement Credit Form


Active Employee Meritain Premier

Active Employee Meritain Standard



Due Process Notification Form

EEO Complaint Form

Employee Corrective Action Form

Employee Grievance Form

Harassment Mediation Resolution Form

Intake Interview Form (Workplace Harassment)



Position Justification Form

Candidate Requisition Form

Personnel Data Sheet

New Employee Onboarding Checklist

Employee Offboarding Checklist

Consolidated Interview Score sheet

Essential Function and Job Analysis Form

Exit Questionnaire Form

Interview Documentation Form

Interview Evaluation Form

Job Description and Evaluation Request

Job Description Worksheet

Notice of Secondary Employment

Reference Check Form 


Family and Medical Leave Notification

Family and Medical Leave Return to Work Medical Certification Form

FMLA Employee Leave Request

FMLA Employer Designation Letter

FMLA Physician Certification of Health Care Provider for Employee

FMLA Physician Certification of Health Care Provider for Family Member

FMLA Return to Work Certification Form

Request for Family and Medical Leave



Expiration of Leave Without Pay Notification

Leave of Absence Request

Sick Leave Transfer Program

Sick Leave Transfer Authorization

Sick Leave Transfer Request


PAYROLL: Please ensure you deliver payroll paperwork in person.

Employee Direct Deposit Authorization Form

Direct Deposit Form (stop)

Generic – Add/Delete Form

Pay Table - Fire & Police

Pay Table - General

W-4 (2018)



General Liability Claim Form

Motor Vehicle Accident Report Form 

On the Job Injury Report 2016



Address Change Form

Application for On-Duty Handgun/Fire Helmet

Change of Status Form

Compensatory Time in Lieu of Overtime Request Form

Confined Space Checklist

Daily Excavation Checklist

Departmental Policy Statement for Overtime Occurring on a Regular Basis

Employee Performance Evaluation Form

Ethics Policy Acknowledgement

Hold Harmless Agreement (Handgun/Fire Helmet)

I-9 (2017)

Identification Card Agreement

Overtime Approval Form

Reasonable Accommodation Process Checklist

Workplace Violence Risk Assessment Checklist

YMCA Deduction Payroll Information

YMCA Membership Application 

YMCA Membership Change Application

YMCA Cancellation Form

The City of Clarksville is an Equal Opportunity Employer




Last updated: 2/6/2019 8:19:34 AM