Introduction to Employee Assistance Forms

This section features the following forms. Please click on the appropriate link at left to be taken to the corresponding forms section.

Child Care and Adoption

Adoption Assistance Reimbursement Request Form
Application for Special Care for Children Assistance Plan
Adoption Assistance Plan Application
Child Care Assistance Program Application Form
Child Care Assistance Program Employee Agreement
Child Care Assistance Program Reimbursement Claim Form
Employee's Child Care Provider Recommendation
Sample Application for Special Care for Children Assistance Plan

Dependents & Child Care

Child Care Needs Survey
Child Care Referral Service Brochure
Child Care Assistance Program Application Form
Summary Plan Description of Dependent Care Assistance Plan
Dependent Care Assistance Plan
Description of Special Care for Children Assistance Plan
Adoption Assistance Plan-Summary Plan Description

Employee Assistance Programs

Employee Assistance Program Awareness Poll
Guide to the Employee Assistance Program
Memo to Employees' Homes Introducing New Employee Assistance Program
Memo to Inform Employees of Newly Launched Employee Assistance Program
Supervisor's Instructions on Employee Assistance Program Procedures

Family Relations

Affidavit of Marriage/Spousal Equivalency
Family-Relations Form
Statement of Family Relationship
Statement of Marriage or Domestic Partnership

Please note that the forms, checklists and policies presented here are for reference only and should not be used without modification. Each company is different, has its own culture, employee requirements and expectations. Laws change, and these Handbooks may not be in compliance with current rules and regulations. In addition, your state may have additional or different laws and regulations not contemplated herein. Consult appropriate local counsel before adapting any form for use in your company. In addition, the links provided herein are provided for your reference. Although we believe these sites to contain useful information, we have no control over their content and, as such, cannot guarantee their reliability.