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Click ‘Get Form’ to open the Benefits Home - Mesa Public Schools document in the editor.
Begin with the Employee Statement section. Fill in your name, address, and Social Security number. Ensure all information is printed clearly.
Complete the Authorization for Release of Medical and Other Information by providing your details and signing where indicated. This allows necessary parties to access your medical information.
In the Employer Statement section, provide your employer's details and ensure they complete their part accurately, including attaching any required documentation like job descriptions or proof of enrollment.
If applicable, fill out the Attending Physician Statement with your physician’s information and ensure they sign it as well.
For optional forms like Direct Deposit Authorization, complete them if you wish to receive payments directly into your bank account.
Review all sections for completeness. Sign and date each form before submission via fax or mail as instructed.
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