Information for Employees

Welcome to the Village of Germantown!  Below are forms needed for full and part time employment. If you have questions about any of these forms, please contact:

 Erin Hirn, Support Service Manager
(262)250-4750 

The Policy and Procedure Manual applies to all employees; everyone is required to sign an acknowledgment of understanding. 

Policy and Procedure Manual
Acknowledgment Non-Represented

1. Ethics Policy & Form
2. 2023 Holidays
3. 2023 Payroll Dates
4. Mileage Log

Required Forms for all New Employees

1. I9
2. Federal W4
3. Wisconsin W4
4. Direct Deposit Fillable
5. Emergency  Information

Info and Forms for Full Time Employees

Health

UMR Enrollment Form

• 2023 Benefits and Enrollment Guide
• HSA Contribution Form 2023 (Silver Plan Only)
• Power Point
• Summary of Benefits and Coverage PPO
• Summary of Benefits and Coverage HD
• Rate Sheet

To comply with the new Transparency in Coverage regulations, UnitedHealthcare/All Savers creates and publishes the Machine-Readable Files on behalf of T&A Industrial LTD. To link to the Machine-Readable Files, please click on the URL provided. Our company specific data will be available as of July 1^st, 2022:  transparency-in-coverage.uhc.com

Dental

Delta Dental Enrollment Form

Flexible Spending

2023 Enrollment Letter

• Diversified Power Point 
• Claims Filing Options
• Debit Card FAQ's
• Dependent Care FSA
• FSA Expense Worksheet
• Health Care FSA

Deferred Compensation

Mission Square

• Deferred Compensation Online
  • Deferred Compensation 457 Enrollment Form
  • Get to know you 457 Plan Video
• Roth IRA Online
  • Roth Enrollment Form
  • Your Payroll Roth IRA Video

North Shore Bank

• Deferred Compensation 457 Enrollment
  • North Shore Bank Deferred Compensation Info Packet

Info and Forms for  Employees Working over 24 Hours

Long Term-Short Term Disability

Income Continuation Insurance

• ICI Information
• Evidence of Insurability

Life Insurance

Life Insurance Application

• Life Insurance Costs 
• ET Life Insurance Fact Sheet
• Power Point

Accident Insurance

Enrollment Form

• Accident Insurance Coverage
• Plan Brochure
• How to File a Claim
• Power Point

Vision

Vision Enrollment Application
Retiree Continuation Application

• Power Point
• Online Services
• Finding a Provider

GO365

• Power Point
• Information

Wisconsin Retirement System

• Beneficiary Designation Form (Please do not return to Employer)
• Calculating Retirement Benefits
• Choosing an Annuity Option
• Guide to Retirement
• Information for Retirees

Notices

• Premium Assistance Under Medicaid and the Children’s Health Insurance Program
• New Health Insurance Marketplace Coverage Options and Your Health Coverage
• Information About Our G365 Program
• Women's Health and Cancer Rights Act Annual Disclosure Notice
• About Your Prescription Drug Coverage and Medicare
• Summary of Benefits and Coverage PPO
• Summary of Benefits and Coverage HDHP