• 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
• Required Fraud Reporting and Training
• Receipt of Ohio Ethics Law Statement - Provide copies of the Ethics Law Overview and the Ethics Law and Related Statutes
  • Ethics Law Overview pages 1-15 and Ethics Law Overview pages 16-27 (2 files due to size of the file)
  • Ethics Law and Related Statutes

Effective July 1, 2024, the State of Ohio is requiring Fraud Reporting and Training. Please visit the link below for more information and to access the 8 minute training video.
https://ohioauditor.gov/trainings/fraud.html

• 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.

• CEBCO Change Request form
• OPERS Change Request form
• Direct Deposit Email Address for Pay Stub (must be submitted to change to the current email on file)