Human Resources

Family & Medical Leave Information

FMLA Request Form
Please fill out and turn in to your building principal.
FMLA Certification of Physician or Practitioner
This form is needed if you are requesting leave for yourself or a family member for medical reasons.
Family or Medical Leave Intermittent Absence Report
This form is needed if you are have been approved for and using family medical intermittent leave for each medical appointment.
Work Status Report Form
This form should be completed by your physician if you will be on a reduced work schedule.
FMLA Posting

Health Care Information

Health Plan Notices of Privacy Practices
FAQ Health Risk Assessment Program
This document contains a list of the most frequently asked questions regarding our Health Risk Assessment Program.
Humana Benefit Summaries 2014
Affordable Care Act (ACA) Glossary of Medical Terms
PPO 1,000 Plan Summary of Benefits
PPO 1,250 Plan Summary of Benefits
HDHP Summary of Benefits
Humana Summary Plan Description 2013-2014
Welcome to your employer-sponsored health care plan administered by Humana Insurance Company. Your employer has provided you with this Summary Plan Description, which outlines your benefits, as well as your rights and responsibilities under this Plan.
Hines Pre-Certification Letter
Hines Outpatient Procedure List
For pre-certification please call Hines at 866-874-8721.
BENCO: Pending or Rejected Claims Memo
NAVITUS Health Solutions
NAVITUS Navi-gate
EBC Flex Account Information
Links you to the EBC website for forms or information on employee flex accounts.

Retirement Information

Wisconsin Retirement System
Links you to the Department of Employee Trust Funds, your source for the Wisconsin Retirement System benefits.
Notice of 403b Plan Eligibility
403b Tax Shelter Information

Payroll Forms

Direct Deposit Agreement
Submit this completed form along with a voided check to the Payroll Office located in the Administration Building.
W4 - 2012

Labor Agreements

CEA Master Contract 2007-2009
Custodial Master Contract 2009-2011
Cleaner Master Contract 2008-2011
Paraprofessional Master Contract 2007-2009
Secretarial Master Contract 2007-2009

The School District of Cudahy does not discriminate on the basis of sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional, or learning disability.

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