Current Employee Benefits and HR Information
We are pleased to provide a wide array of benefits for our employees. New employees enroll in benefits at the start of their job. Employees can change their choices either annually during the “open enrollment” period in May or with a qualifying event (such as the birth of child or a change in a spouse’s employment).
This page contains a number of forms and documents related to benefits and human resources. Click on a category to find the links.
2021-22 Insurance Information
- Benefits Enrollment Log-in and Process
- Benefits Overview Booklet. Includes:
- Heath Insurance Plans and Rates
- Delta Dental Plan
- Eye Med Supplemental Vision Plan
- FlexFacts Healthcare FSA and Dependent Care FSA
- Other offerings and additional details
- Login Web Site
- For login instructions, see page 5 of Benefits Overview Booklet
- Pierce Group Benefits Personalized Charlottesville City Schools Website
- Benefits Overview Booklet. Includes:
- Aetna Mail Order Rx Brochure
- Virginia Retirement System Life Insurance Overview
- Optional Additional Life Insurance : see HR
- Other forms and logins
- Medical and Dependent Care FSA Claim Form for Flex Facts (2020-21)
- Insurance Opt-Out Form (for grandfathered employees)
- Employee Assistance Program through U.Va.
Handbooks
- Employee Handbook — 21-22 coming soon
- Teacher Evaluation Handbook 21-22
- Administrator Development Evaluation Program 21-22
Miscellaneous Forms and Information
- Reimbursement Request
- Mileage Reimbursement Form
- Tuition Reimbursement
- Name/Address Change Form
- Designation of Beneficiary
- Resignation Form
- Request for Resignation Sick Leave Payout
- Sick Leave Transfer Request Form
- Dependent Care Claim Form (WageWorks)
- Medical FSA Claim Form (WageWorks, 2019-20)
- Medical FSA Claim Form (Flex Facts, 2020-21)
- Verizon Wireless Discount Information
- Sprint Discount Information
- Administrator Evaluation Development Program
Payroll Forms
- VA-4 State Taxes
- W-4 Federal Taxes
- I-9 Employment Eligibility Verification
- Payroll Distribution Form
- FLEXCOMP Explanation
- 403(b) Salary Reduction Agreement
- 457 Deferred Compensation Plan
- Prior Service Buy-Back Agreement: see Payroll Coordinator
Retirees’ Forms and Information
- Retirement Checklist
- Retirement Resignation Form
- Application for VRS Retirement
- Application for VRS Disability Retirement
- Request for VRS Defined Benefit Plan Refund
- Request for VRS Income Tax Witholding
- Authorization for VRS Direct Deposit
- Request for VRS Health Insurance Credit
- Request for Retirement Sick Leave Payout
- Virginia Retirement System Life Insurance Overview
- Designation of Beneficiary
Retirement Planning and Savings
- Virginia Retirement System (VRS) Login
- 457 Deferred Compensation through VRS
- 403(b) Tax-Sheltered Account Information
- Supplemental Retirement Plan “Meaningful Notice”
- Prior Service Buy-Back Agreement: see Payroll Coordinator
- Request for VRS Estimate of Retirement Benefits
Training
- For information about periodic or ongoing professional learning, call 434-245-2965.
- Child Abuse Recognition and Intervention Training
- Click here for Title IX information and training materials
Wellness Program Forms
- Employee Assistance Program through the University of Virginia (a free, confidential resource to help address personal issues)
- Care Solace Appointment Assistance. In addition to the Employee Assistance Program, we partner with Care Solace to provide free, confidential assistance making appointments for staff, students, and families who need assistance with mental health, substance abuse, and more. Visit their website or call 888-515-0595.
- Health Club Access