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For Employees

CRMC C: More


Employee Self Service


Human Resources Forms/Information

Roth Comparison

Am I a Good Candidate for Roth Contributions?

IT-2104 – Employee Withholding Allowance Certificate Form

W-4  – Employee Withholding Allowance Certificate Form

Address, Telephone and E-mail Address Change

Direct Deposit Authorization Form

Direct Deposit Amendment/Cancellation Form

Employee Requisition

HIPAA Breach & Discipline Policy

I-9 Form

In House Application

Key Request

NYSNA Continuing Education Form

Parking Permit Application

Personnel Action

Transfer Request

Travel Expense Report

Vacation Request

Verification of Education

Voluntary Self Identification Form


Evaluation Forms

Cover Sheet Jacket for Evaluation CRMC 2015

Evaluation Instructions CRMC 2015

Overall Rating Sheet 2015

Always Events Evaluation Form


Employee Health Forms/Information

Employee Annual Assessment

New Hire Pre-Employment Assessment

New Employee Checklist


Benefit Forms/Information

Delta Dental

Disability and Family Medical Leave Information

Employee Assistance Plan

Flexible Spending Reimbursement

Life Insurance

Medical Opt Out

Principal Financial Group Information

Tuition Reimbursement

2017 Medicare Part D Creditable Coverage Notice

2016 CHIPRA Notice



2017 Code of Conduct & Corporate Compliance Plan

Code of Mutual Respect

Confidentiality of Information (Patient and Public)

Dress Code

Employee Confidentiality Agreement

Fragrance Control


Employee Handbook Receipt

Network Access


Smoke Free

Social Networking

Email Communications Guidelines

Cellular Phones, Personal Pagers, Tape Recorders and other Electronic Devices

Unscheduled/Sick Time Off



403(b) Investment Change Notice – 3/15/2017

Qualified Default Investment Alternative (QDIA) Notice – 02/01/2017

403(b) Investment Option Summary – 12/31/2016

403(b) Investment Change Notice – 8/1/2016

403(b) Investment Option Notice – 8/1/2016

403(b) Notice of Fee Change – 8/1/2016

403(b) Notice of Mutual Fund Name Change – 8/1/2016

403(b) Investment Option Summary – 2/1/2016

403(b) Qualified Default Investment Alternative – 2/1/2016

2015 Profit Sharing Plan Investment Option Summary

2015 Profit Sharing Plan Investment Change Notice


Summary Annual Reports

2014 Plan Year – 403(b) SAR

2014 Plan Year – Health & Welfare SAR

2014 Plan Year – Profit Sharing SAR

2013 Plan Year – 403(b) Summary of Material Modification


Please contact our Human Resources Department if you need further assistance.
To speak with a member of our Human Resources staff, please call 845-794-3300 ext. 2045