Human Resources » Forms

Forms

Payroll Forms
Visit the Payroll Department page at https://www.bensalemsd.org/apps/pages/index.jsp?uREC_ID=1237220&type=d&pREC_ID=1449825  for the following payroll forms and more: 
  • Change of Address (must also complete residency form)
  • EIT Residency Form 
  • Direct Deposit Form
  • W4
  • Pay schedule
No Pay Day Form: This request form must be completed if the employee is seeking to take time off but does not have available leave days such as sick, personal, etc. 
 

Requests for Unpaid Leave in excess of the paid leave days provided (sick, personal, etc.) to an employee should only be made in limited circumstances and for good cause.  Family emergencies, qualifying medical reasons, birth of a child, and other exigent reasons may justify approval for an unpaid leave/use of no-pay days.  If the employee is already approved for a qualifying medical leave during this school year, this form does not also have to be completed. Decisions will be made on a case by case basis, at the discretion of the District, based on the circumstances. 

 
Secretaries processing payroll for an employee seeking or approved for a no-pay day must still input an absence in the Time Clock Plus system.  
Bereavement Leave Form:  Effective the start of the 19-20 school year all staff taking a bereavement day must fill out the form below and send it to Human Resources when taking bereavement leave. 
 
This does not relieve your obligation to follow applicable call out procedures.  Please continue to call out as usual and mandated for your employee group. 
ADA Accommodation Request Forms: If you are seeking an accommodation from your job duties due to a disability, the forms below must be completed. The purpose of these forms is for an employee to request an accommodation and for the School District to determine whether, or to what extent, a reasonable accommodation is required for an employee with a disability to perform one or more essential functions of their job safely and effectively. Reasonable accommodations will be provided to qualified employees with disabilities, unless doing so would pose an undue hardship. A qualified employee is one who can perform the essential functions of the job with or without a reasonable accommodation.