Enrollment Form - Active DONE - lausdemployment 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your Employee Number, Last Name, First Name, and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for processing your application.
  3. Fill in your Address, City, State, and Zip Code. This ensures that all correspondence reaches you without delay.
  4. Select your Retirement Date and indicate whether you are applying for Service or Disability Retirement by checking the appropriate box.
  5. Choose your desired Health Plans from the options provided. Make sure to review eligibility requirements for each plan before making a selection.
  6. Complete the Dependent Information section if applicable. Remember that Social Security numbers are mandatory for all dependents listed.
  7. If you or your spouse is over 65, fill out the Medicare Information section and attach a copy of the Medicare card as required.
  8. Finally, sign and date the form at the bottom to confirm that all information is accurate and complete before submitting it to Benefits Administration.

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K-12 Open Enrollment Home Parents or guardians who want to enroll their child at a school other than their current school of attendance must complete an open enrollment application. For 2025, the District K-12 Open Enrollment on-time application period will be April 21 to May 9, 2025.
Please call us at 213-241-5300 for information related to employee leaves, benefited time, other supports, and subsidies. You may also e-mail recruit@lausd.net.
Visit our Intranet site at the LAUSD Homepage. Click on Employment, and then go to Employment Verification. For more information, call the Client Service Center at 1-800-996-7566 to speak with a Customer Service Representative or visit The Work Number Homepage.
Best Practices for Employment Verification Calls Only trained HR professionals should handle employment verification callsnot front desk staff or untrained managers.
Contact the Office of Employee Relations-Employment Verification Unit via email at employeeverify@lausd.net. To expedite processing, please email or fax us [(213) 241-8404] the verification report from The Work Number, along with your request.

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For CSEA employees hired on or after September 1, 2018, years of qualifying service and age must total at least eighty-seven (87) in order to qualify for retiree health benefits. This must include a minimum of thirty (30) consecutive years of service with the District immediately prior to retirement.

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