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PRINTABLE FORMS - PDF
These forms have been made available to you in standard PDF (printing/download format).
You will be given a choice between printing a form immediately or saving it to disk for later use.
If you don't currently have Adobe® Acrobat® Reader, download it here:
 http://get.adobe.com/reader/
General Forms & Numbers:
 CWA Constitution as Amended July2008 PDF
CWA Constitution 2006 PDF
http://www.unionplus.org/college-education-financing/scholarships
CWA National Joe Beirne Foundation Web-site
http://www.cwa-union.org/members/beirne/
http://www.cwa-union.org/members/beirne/application.html
CWA/NET ACADEMY
http://www.cwanett.org
LEGAL SERVICES
FOA/disability and workers comp. 212-267-1650
http://www.foalaw.com/
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Forms for Verizon Workers:
Verizon NY Absence Control Plan PDF
Absentee Information:
Verizon/short term disability 800-638-4228
SHORT TERM DISABILITY (STD) (WEEKS 2 -52)
YOU NEED TO CALL MET LIFE ON OR BEFORE THE EIGHHT CALENDER DAY OF YOUR ABSENCE.
ON YOUR FIRST DAY OF AN ABSENCE
CALL YOUR SUPERVISOR/ABSENCE ADMINISTRATOR
DO NOT DISCUSS ANY DETAILS OF YOUR ILLNESS
ADVISE THEM THAT YOU WILL BE OUT OF WORK
BECAUSE YOU ARE ILL AND THAT YOU WILL
RETURN WHEN YOU ARE FEELING BETTER.
BEGINS ON THE EIGHTH CALENDAR DAY OF YOUR ABSENCE
ON THE EIGHTH CALENDER DAY OF AN ABSENCE YOU MUST CALL METLIFE
KEEP TRACK OF WHO YOU SPOKE WITH, THE DATE, THE TIME
AND ANY INFORMATION THAT THEY ARE REQUESTING FROM YOU
OPEN ENROLLMENT
OPEN PACKET AND READ IT
(see above note)
VERIFY ALL INFORMATION
NAME'S, ADDRESS'S, SOCIAL SECURITY NUMBERS ETC.
FOR YOURSELF AND ALL DEPENDENTS
IF YOU HAVE ANY QUESTIONS OR PROBLEMS
CALL BENEFITS 1-877-ASKVZHR AND
KEEP TRACK OF WHO YOU SPOKE TO AND WHEN
DEPENDENT AUDIT
IF YOU RECEIVE ONE
MAKE SURE YOU RESPOND TO IT
BY THE DATE SPECIFIED
IF YOU DO NOT
YOUR DEPENDENTS WILL BE DROPPED
AND WHEN THEY ARE ADDED BACK
COVERAGE WILL NOT BE RETROACTIVE
EVERY EFFORT IS MADE TO KEEP THIS INFORMATION UP TO DATE AND ACCURATE.
IF YOU FIND ANY DISCREPANCIES PLEASE LET US NOW AS SOON AS POSSIBLE. THANKS
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Aetna Medical Claim PDF
Aetna Dential Claim PDF
Aetna Vision Claim PDF
Aetna 800-448-6458
http://www.aetna.com/index.htm
https://www.aetna.com/member/
Aetna/United Behavioral Health 800-852-1084
Verizon Empire Blue Cross Blue Shield claim PDF
Blue Cross/Blue Shield 800-635-2184
http://www.empireblue.com/
Davis Vision Claim Form information PDF
Davis Vision Claim Form PDF
Davis Vision/Lasik 877-999-7006
http://idoc.davisvision.com/davis/public/default_home.htm
Empire Blue Cross Blue Shield Dental Expense Claim Form PDF
Metlife Authorization Form PDF
Metlife Dental Claim Form PDF
Dental/Met Life 800-556-3490
http://www.metlife.com/dental
Dependent Care Reimbursement Fund Application PDF
Dependent Care Reimbursement monthly form PDF
DISABILITY Met Life Form PDF
DISABILITY Metlife Authorization To Disclose Info PDF
Medco Mail in Precription Form PDF
Medco Health/prescription drugs 877-877-1878
http://www.medcohealth.com/medco/consumer/home.jsp
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F.M.L.A. Medical Certification Form PDF
The 1993 Family and Medical Leave Act allows eligible employees to take up to 12 weeks of unpaid leave in a 12 month period. The leave can be taken for the birth, adoption or foster placement of a child, the care of a family member with a serious health condition or the employee's own serious health condition.
What is a "serious health condition''?
The act does not specifically define this term. At present, the Department of Labor has defined it as involving the following circumstances, any illness, injury or physical or mental condition that involves:
(a) inpatient care in a medical facility or
(b) incapacity requiring 3 days' absence from work, school or other daily activities and
(c) supervision or continuing treatment by a health care provider, or
(d) a chronic, long-term or incurable condition which is under the care, supervision or
treatment of a health care provider and if untreated would result in at least 3 day's incapacity from work or other daily activities.
FMLA is a powerful tool that can be used to protect our members. It is a valuable asset to any employee or family member who may have a reoccurring illness and or medical condition. An approved FMLA case is not subject to the disciplinary actions of the Absence Control Plan (i.e. you cannot be stepped while on an approved leave). All paperwork must filled out and signed by your doctor as soon as practical.
*By law FMLA papers must be sent to you on the third day of any absence.
FMLA Updated PDF Forms January 2009
Family Medical Leave PDF
Employee Rights & Responsibility PDF
FMLA Frequently Asked Questions 2009PDF
FMLA REG 2009 PDF
FMLA Things you need to know PDF
The National Partnership for Women & Families Summary PDF
2009 Verizon Health Plans Comparative Analysis PDF
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Verizon Educational Services
In most cases,
VERIZON will pay 100% of YOUR TUITION
For an accredited school of your choice!
TAP
VZ Tuition Assistance Program info PDF
VZ Tap Tuition Assistance Application PDF
Apply on line or call (866) 944-3470 for an application
http://secure.tamsonline.org/TAMS3Web/VZTAP
Verizon Scholarship Web-site Deadline February 1
https://www.scholarshipamerica.org/verizon/
Miscellaneous info:
Verizon Benefits/ask VzHR 877-489-2367 or???? 877-275-8947
http://resources.hewitt.com/verizon/
Verizon Savings Plan 888-457-9333
Fidelity Netbenefits Login
https://login.fidelity.com/ftgw/Fidelity/NBPart/Login/Init?AuthRedUrl=
https://workplaceservices300.fidelity.com/NBHome.html
Verizon Workplace Concerns
1-800-856-1885
Employee Assistance Plan – VZ Life
1-800-845-0632
You and your dependents are entitled for up to five (5) free Counseling sessions per issue.
HR Help Line
1-877-Ask VZ HR (1-877-275-8947)
Or @ www.resources.hewitt.com/Verizon – type in SS# & Passcode
Verizon Benefits Center
1-877-Ask-Vzhr (1-877-275-8947)
CWA_Safety_Brochure PDF
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Forms for Frontier / Citizens
No forms available at this time.
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Forms for Arnot Ogden Medical Center
Arnot Health Application for Employment PDF
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Forms for Woodbrook Adult Home
No forms available at this time.
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Forms for Elmira School Bus
2009-10 School Calender PDF
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Forms for Chemung Town Highway
No forms available at this time.
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Forms for Savvy Fleet
No forms available at this time.
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Forms for AT&T Cellular Mobility
No forms available at this time.
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AFL-CIO