• Employment Eligibility Verification, USCIS Form I-9 (expires 07/31/2026)
• Payroll Change Notice
• Employee’s Withholding Certificate, W-4
• Employee’s Withholding Exemption Certificate, IT 4 (revised 01/24)
• City Income Tax Liability
• OPERS Personal History Record/Elected Official Membership
• Statement Concerning Your Employment in a Job  Not Covered by Social Security
• Acknowledgment of receipt of Auditor of State fraud--reporting system information
• Direct Deposit Form (must ALSO include direct deposit form from bank or voided check)
• Public Employment Declaration
• CEBCO - Medical & Dental (if not electing, still need to mark waived and provide signature)
• New Health Insurance Marketplace Coverage Options
• Wellness Check Confirmation Form
  • Primary Care Physician (PCP) Differential Program Information

• Authorization for Voluntary Payroll Deduction
• Employee Emergency Contact Form
• Request for Taxpayer Identification Number and Certification (Form W-9)

Contact your supervisor for more information regarding the following benefits:

• Guardian - Offering Short Term Disability, Critical Illness Insurance, Accident, Hospital Indemnity and Life Insurance.
• Gold Circle - Savings, Christmas Clubs, Loans, etc. Applications available upon request in the Auditor’s Office.
• Identity Theft - Identity Theft coverage through Norton LifeLock Benefits Solutions.
• County Commissioners Association of Ohio (CCAO-Empower) - pre-taxed deferred or Roth program designed for retirement savings contributions.
• Ohio Public Employees Deferred Compensation - pre-taxed deferred compensation retirement savings account.
• Ameriflex - Offering Flexible Accounts (FSA) and Dependent Care Accounts (DCA).
• Equitable - Offering financial advice in the development of structured annuities, variable annuities, 403(b) Plans and Universal Life Policies.