Forms for FCI Employees
FCI Payroll Forms
These forms should be completed by anyone on FCI's payroll.
Mileage Reimbursement Form
Download and fill in the Excel document to submit mileage reimbursement requests. Note that the mileage reimbursement rate may change each year.
Health Insurance Forms
Upon hire, benefits-eligible FCI employees are expected to enroll in health and/or dental insurance or to waive insurance coverage. Employees with a spouse/domestic partner and/or dependent children are expected to certify eligibility for dependent benefits.
Flexible Spending Account Forms
FCI employees who want to set up a health or dependent care Flexible Spending Account should self-enroll using these instructions.
Health Reimbursement Account Forms
Employees who are enrolled in FCI's health insurance and have established a Health Reimbursement Account may use this form to request reimbursement of eligible expenses.
Life Insurance Benefits Forms
Retirement Plan Forms
Massachusetts Paid Family and Medical Leave (MA PFML) Acknowledgement Form
At the start of employment, employees are expected to review and acknowledge the MA PFML benefits and wages deduction for this program. Individual employees and Five Colleges, Incorporated and contribute to the program cost. The contribution rate is set annually by the Commonwealth of Massachusetts. These documents provide employees notice of the benefit and of the effective rate.
Tuition Benefit Forms
These forms are for FCI employees seeking tuition support for themselves or their dependents.
These forms are for FCI employees and supervisors to use when evaluating job performance.
Request for Accommodations Forms
In accordance with the ADA, FCI will provide reasonable accommodations (unless doing so would cause significant difficulty or expense) for job applicants and employees. A reasonable accommodation is any change in the work environment (or in the way things are usually done) to help a person with a disability apply for a job, perform the duties of a job, or enjoy the benefits and privileges of employment. Employees may request a reasonable accommodation using this form.
Leave Request Forms
These forms are for FCI employees applying for leave.
Flexible Work Arrangement Forms
An FCI employee who would like to apply for a flexible work arrangement should review and complete these forms with their supervisor.
Other Benefits-Related Forms
FCI employees must report within 24 hours any workplace accidents and injuries incurred at work or while performing a job-related function required by FCI. The First Report of Work-Related Accident Form should be used to report the incident to the supervisor and to the Director of Operations.