Jacobs Field Services North America, Inc. Craft Benefits ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the type of activity you are applying for, such as New Hire/Rehire or a Qualifying Life Event. Check all applicable boxes.
3. Fill in your personal information in Section II, including your name, address, and last four digits of your Social Security Number.
4. In Section III, provide details about any dependents you wish to enroll. Indicate their relationship to you and check the appropriate boxes for medical, dental, and vision coverage.
5. Proceed to Section IV to select your desired benefit plans. Make sure to check the boxes for each plan you want and indicate if you are waiving coverage.
6. Complete Section VI by signing and dating the form to authorize payroll deductions for your selected benefits.

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