Accident/Workers Compensation

If you have an injury or accident at work, you must report it to the human resources office immediately. Here’s what you need to do:

  1. The employee fills out the Workers Compensation Incident Report
  2. The supervisor fills out the Accident Investigation Report
  3. The employee fills out the Choice of Doctor Form.
  4. Send all forms to the HR office as promptly as possible.

Workers’ Compensation Incident Report

Accident Investigation Report

Choice of Doctor Form

Beneficiary Changes - Forms

If changing beneficiaries, please send all forms to the HR office. Do not send them directly to the financial institution.

NPERS Beneficiary Form (You can send this directly to NPERS if you wish. Form must be notarized–Kate in HR can do this.)

Sun Life Beneficiary Change Form

Lincoln Financial Beneficiary Change Form

Benefit Forms

Our benefits are subject to open enrollment guidelines and are not available to enroll in at all times. If you qualify for a special enrollment period or wish to cancel certain benefits, some of those forms can be found here. If it is not open enrollment, contact HR to discuss your benefit options.

BCBS Cancellation Form

FMLA

Employees who work at least 1250 hours in the 12 months prior to a qualifying absence may be eligible for FMLA. If you question your eligibility, please call HR at 402-727-3016. If you know you are eligible or have been directed here by HR, please complete the application below and send to Kate in Human Resources.

FMLA Leave Application

Name Change - Forms

You must present your new social security card to the HR office, in person, prior to changing your name anywhere in the district. All documents sent to the district offices must have your legal name on them. We don’t know nicknames or other names you might go by. Please help us out.

When changing your name, you will need to complete some or all of the forms below. Call HR at 727-3016 to make an appointment and if you’d like to save time, feel free to print and fill out the following forms prior to your appointment.

W-4
Direct Deposit
Blue Cross Name Change Form
Sun Life Name Change Form
Lincoln Financial (Voluntary Life Insurance) Name Change Form

Resignation

If you have decided to leave the district, you are required to fill out two forms.

Classified Employees
1. Complete the Separation Notice and give to your immediate supervisor.
2. Complete the NPERS School Plan Member – Certification Form and send to NPERS via the fax number listed on the top of the form.
3. Access information here regarding leaving the Nebraska Public Employees Retirement System and what to do next.

Certified Employees
1. Please write a letter of resignation and give it to your administrator.
2. Complete the NPERS School Plan Member – Certification Form and send to NPERS via the fax number listed on the top of the form.
3. Access information here regarding leaving the Nebraska Public Employees Retirement System and what to do next.

Substitute Lists (Accessible to Designated Staff Only)

Classified Substitute List – To obtain access to this list, contact the Human Resources office at hr@fpsmail.org or 727-3016.

Building Phone List for Sub Paras – Attention substitute paras! Access this link for a comprehensive listing of all phone numbers for the school offices as well as a message from HR!

Translators & Interpreters List (Accessible to Designated Staff Only)

Translator & Interpreter List – To obtain access to this list, contact the Human Resources office at hr@fpsmail.org or 727-3016.

Our Employees Are Our Most Valued Resource.

If you would like to review the District’s Statement of NonDiscrimination, please visit the FPS Statement of NonDiscrimination.

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