HR Forms
MONDAY, MARCH 23, 2020: Governor Inslee "Stay Home Stay Healthy" Proclamation
For business related inquiries please call 425.275.4823

INSTRUCTIONS: Please make sure to submit copies of all completed forms directly to HR.


ADDRESS CHANGE FORMS (please also make sure to notify HR as well so that your information may be updated with our MEBT recordkeepers and in our payroll system):

 AWC (health insurance) form

Deferred compensation (requires direct notification by you to your dcp provider- see the deferred compensation tab for contact information)


Emergency Contact Personnel File Information form

DRS state retirement system (PERS & LEOFF) form


BENEFICIARY CHANGE FORMS (please also make sure to notify HR)

Cigna Life Insurance, LTD & AD&D

MEBT Beneficiary Form (For MEBT and MEBT Life Insurance)

DRS State Retirement (PERS & LEOFF)



See Beneficiary Change Forms above

AWC (health insurance) enrollment form -adding (spouse, registered domestic parter and/or dependents) or removing a former spouse, registered domestic partner and ineligible dependents)

**You may also be required to update your I-9 and W-4 forms on file. Please notify HR in the event of a marriage status or name change


Payroll Deduction Change Forms 

Direct Deposit

W-4 Form

MEBT Contributions

DRS - Deferred Compensation

Change online at

Change via secure phone call to 888-327-5596

Nationwide Deferral Change Form

ICMA-RC Amount of Deferral Change Form

Human Resources Contact Information

Please use the below contact information if you need HR assistance.

Secure Fax:   425-275-4806

Please email Carly Derrick for employment verifications


Jessica Neill Hoyson, HR Director

Phone: 425-771-0258

 Emily Wagener, HR Analyst

Phone: 425-775-7740

 Carly Derrick, HR Assistant (part-time)

Phone: 425-672-5751 

 Craig Cottrell, Safety & Disaster Coordinator