Champaign County, Illinois
Local Government Information Center
 
 

Forms for Department Heads & Employees

Department Heads
Grant Consideration, Acceptance, Renewal/Extension Application
Grant Financial Impact Statement
Employee Acknowledgement ITR Policy Form (PDF)
Long Distance Phone Charges Payment Authorization Form
Travel Log
Unpaid Leave Form
Personnel Forms
Personnel Information Form Guide
New Hire Form
Termination Form
Transfer/Promotion/Demotion/Other Form
Employee Forms
Flexible Spending Account/HRA Reimbursement Form
Parking Request
Auditor's Forms
Fixed Asset Equipment Change Form
County Liability/Property/Auto Loss Forms
Incident Report for All Claims Form
Automobile Loss Notice Form
Liability Loss Notice - Citizen Form
Liability Loss Notice Form
Property Loss Report Form
Emergency Management Agency Forms
Emergency Plan Worksheet
COOP Planning Guide
Payroll Forms (*Internet Access Required)
2014 Fringe Benefits Costs
2014 Payroll Calendar
2014 Non-Bargaining Salary Schedule
Direct Deposit Authorization Form
Direct Deposit Cancellation Form
Direct Deposit Fact Sheet
*Federal Withholding Form W-4
*Illinois Withholding Form W-4 Booklet
Worker's Compensation (*Internet Access Required)
Carle Occupational Medicine New Location 10/12/09
Worker's Compensation Forms - Authorization for Treatment
Worker's Compensation Forms - Employee Injury Report
Worker's Compensation Forms - Medical Authorization Form
Worker's Compensation Forms - Supervisor Report
Worker's Compensation Forms - Witness Report
* Illinois Worker's Compensation Handbook
Domestic Partnership Forms
Resolution No. 5209 - Adoption of Domestic Partner Statement & Policy for Champaign County, IL
Declaration of Domestic Partnership Form
Registration of Domestic Partnership Affidavit
Affidavit of Termination of Registered Domestic Partnership
Information When Leaving the County
Termination Checklist
Termination Packet
What Every Worker Should Know About Unemployment Insurance
Unemployment Insurance Benefits Handbook

FMLA (Family Medical Leave Act)

FMLA Regulations (*Internet access required)
*Fact Sheet on the Final Regulations (PDF)
*Revised FMLA Poster (PDF)
FMLA Employee Forms (*Internet access required)
*WH-380-E Certification of Health Care Provider for Employee's Serious Health Conditions (PDF)
*WH-380-F Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
*WH-384 Certification of Qualifying Exigency For Military Family Leave (PDF)
*WH-385 Certification for Serious Injury or Illness of Covered Service member -- for Military Family Leave (PDF)
FMLA Supervisor Forms (*Internet access required)
*WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)
*WH-382 Designation Notice (PDF)