CZU PERSONNEL
PO DRAWER F-2, FELTON, CA 95018

For all personnel related questions, please email: CZUPayrollHelp@fire.ca.gov

PERSONNEL FORMS
Employee Action Request
Std. 686

Used for Address and Withholding Changes
Emergency Notification Information
CDF 31

Used for Emergency Contact Information and Physician Designation
in the event of a Workman's Comp injury
 
Paycheck Calculator
Direct Deposit Form
Std. 699
 

Payday Calendar

Personnel Demob Form
BENEFIT ENROLLMENT FORMS
Health Enrollment - Form HBD 12
Used for Health Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period
Dental Enrollment - Form Std 692
Used for Dental Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period
 

VSP Basic Vision Enrollment

VSP Premier Vision Enrollment
This is used for VSP Premier Enrollment, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or
Open Enrollment Period. *Basic vision coverage is automatic and does not require and enrollment form.

COBEN Cash Enrollment Form
Used for Flex Cash Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period for BU 7, 8, and Excluded
 
Flex Elect Dependent Care/Medical Reimbursement Enrollment
Used for Flex Dependent/Medical Reimbursement Enrollments,
Additions, or Deletions of Employee and/or Dependents upon qualifying
permitting event or Open Enrollment Period

Flex Elect Cash Option Enrollment
Used for Flex Cash Option Enrollments for BU 1, 4, 12, & 13.
Additions, or Deletions of Employee and/or Dependents upon qualifying
permitting event or Open Enrollment Period

 

FFI Separation Packet Forms
(Submit all completed, signed forms to Personnel upon separation.)

FFI Separation FAQs

 

Members can access CalPERS customized
Health Plan Statements online at my|CalPERS.

For assistance creating or logging in to your account, refer to:
How to Register for & Access my|CalPERS (PDF)

 

Benefit Rate Calculator

Health Plan Search by Zip Code

 

Health Program Guide

Health Benefit Summary

CAL HR Dental Benefits

CAL HR Vision Benefits

CAL HR Flex Elect Benefits

CAL HR CoBen Benefits

 

REMINDER!!!
Health, Dental, and Flex Elect benefit enrollment changes
each require their own completed signed form for each type of benefit plan being modified.

These forms are contracts between the employee
and the state and require original signatures.

Changes cannot be made over the phone!

It is incumbent upon the employee to ensure that they have submitted all of the necessary forms,
listing all desired changes for each plan
in the timeframe allotted.

 Please mail your completed, signed forms to:
CZU Personnel

PO Drawer F-2
Felton, CA  95018

REMINDER!!!
Due to recent health care reform, dependent children can now be covered up to age 26
regardless of student, residency, or marital status.

In addition, social security numbers and proof of eligibility are now required for all dependents.

 

BENEFIT LINKS

Health Plan Websites

Dental Plan Websites

Vision Services Plan (VSP) Website

Flex Elect Handbook

 

The Work Number for Everyone
Used by employees to provide employment and salary verification
for lending agencies per CAL FIRE policy.
No verification is done through the Personnel office.
Instructions

 

Respiratory Protection Program (RPP)
The RPP Questionnaires have been mailed out to those permanent and limited term personnel
who are required to complete this information annually. Click here to learn more

 
2021 Holiday Schedule
Date Holiday
Friday, January 1 New Year's Day Observed
Monday, January 18 Martin Luther King Jr. Day
Monday, February 15 Presidents' Day
Wednesday, March 31 Cesar Chavez Day
Monday, May 31 Memorial Day
Monday, July 5 Independence Day Observed
Monday, September 6 Labor Day
Thursday, November 11 Veterans Day Observed
Thursday, November 25 Thanksgiving Day
Friday, November 26 Black Friday
Saturday, December 25 Christmas Day
 

OTHER LINKS:

BARGAINING UNIT MOUs: http://www.calhr.ca.gov/state-hr-professionals/Pages/bargaining-units.aspx

BENEFIT ADMINISTRATION MANUAL: http://www.calhr.ca.gov/state-hr-professionals/Pages/benefits-administration-manual.aspx

STATE COMPENSATION INSURANCE FUND: http://www.statefundca.com/

EMPLOYEE ASSISTANCE PROGRAM: www.eap.calhr.ca.gov

SAVINGS PLUS NOW (401(k) & 457 Plans): https://www.savingsplusnow.com/
***SAVINGS PLUS FLYER
***

COLLEGE SAVINGS PLAN: http://www.scholarshare.com/

GROUP LEGAL:https://www.araggroup.com/

LONG TERM CARE: https://www.calpers.ca.gov/page/active-members/health-benefits/long-term-care

THE WORK NUMBER FOR EVERYONE (Employment/Salary Verification): http://www.sco.ca.gov/ppsd_se_worknumber.html