Forms

• Change of Address Form
  This form will update payroll, benefits, and your employee record with your new address. If you have changed your name, please contact payroll and provide documentation showing a legal name change.
• Direct Deposit Form - contact payroll
• Flexible Spending Plan forms
• Form W-4 (PDF) (federal taxes)
• Form M-4 (PDF) (state taxes)
• Leave Request Form (DOT)

Forms for your health insurance fitness reimbursement and mail order prescriptions can be found on our Employee Discounts Page.

If you need additional forms to update your benefits, check the Benefits Page or contact the Treasurer's Office at 781-270-1623.

Family / Medical Leave (FMLA)

If you will be out to care for a family member or for your own serious health condition, you may be eligible for job protections through the Family Medical Leave Act (FMLA) (PDF). Submit these forms to Human Resources to assist us in providing this benefit to you. All materials will be maintained confidentially and may be faxed to 781-238-4696.

• Employee Request Form
  • Healthcare Provider Certification Form (PDF) - for an employee's health condition
  • Healthcare Provider Certification Form (PDF) - for a family member's health condition
• FAQs for Town Employees (PDF)
• FAQs for School Employees (PDF)
• FAQs from the Department of Labor

When you return, you will need to provide a note from your doctor letting us know that you are cleared to return to work. If you are released to work with accommodations, we will need to know that as well in order to determine if those requests can be put into place. For your convenience, you may provide the Fitness for Duty Certification and Notice of Intent to Return to Work (PDF) for your doctor to complete.

Families First Coronavirus Response Act (FFCRA)

In effect April 1, 2020 through December 31, 2020

• FAQs from the Department of Labor
  
• FFCRA Request Form
• FFCRA Workplace Poster (PDF)
• Town of Burlington's Implementation of the FFCRA (PDF)

Eligible employees are entitled to a combined total of 12 weeks of Federal FMLA and FFCRA in a 12 month period.