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December 17, 2017
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Downloadable Forms

Downloadable Forms For Local 21 Membership



DFSS Form 13 Long Term Leave Workability and RTW Certification
Mar 15, 2017

Download: DFSS Form 13 Long Term Leave Workability and RTW Certification 03012017.pdf

Form 18 Time Off Request
Mar 15, 2017

Download: DFSS Form 18 WORD DOC.docx

CieloStar Medical And Dependent Care Reimbursement Claim Form
Dec 11, 2017

Download: CSP Claim Form 2017.pdf

WORK RELATED - WORKABILITY FORM
Oct 07, 2015

Download: Workability Form 10-7-15.pdf

Sick Slip - DFSS Form 29
Mar 02, 2016

Download: DFSS Form 29 NEW 03012016.pdf

DFSS Form 18A Extended Sick -Family Leave Request 6-23-15
Feb 06, 2016

Download: DFSS Form 18A Extended Sick -Family Leave Request 6-23-15.pdf

Employees Safety Report Form 12
Nov 30, 2017

Download: Employee Safety Report Form 12 w-Addendum 113017.pdf

Supervisors Safety Report Form 12A
Nov 30, 2017

Download: Supervisor Safety Report 12A w-addendum 113017.pdf

Local 21 Political Action Committee Donation Form
May 25, 2015

Download: Local 21 Political Action Committee Donation Form.pdf

LOCAL 21 NEW MEMBERS APPLICATION
May 25, 2015

Download: LOCAL 21 APPLICATION FOR MEMBERSHIP.pdf

Charitable Gambling Donation Request Form
May 25, 2015

Download: 2014 SPFF Donation Request Form.pdf

Mileage Request Form
May 25, 2015

Everyone Local 21 member is encouraged to download and fill out this form.   The Mileage Request Form lets payroll know you may be putting in for mileage sometime down the line.  Everyone should be filling this out now.  Especially the people getting detailed.  If you have any questions regarding this process contact Local 21 Treasurer Randy Bibeau, Station 24-A

Our Bargining Unit is: 03
All L-21 members are Occasional Drivers
Mark down IRS Rate
Check the ADD box
Justifications Include:
     -Movement to other stations
     -Training away from stations
     -Detailing to other stations during the day
     -Others


Download: Mileage Request Form.pdf

Daily Mileage Form
May 25, 2015

Download: Mileage_Daily_Form.pdf

Monthly Mileage Form
May 25, 2015

Download: Monthly Mileage Report-2006-2.pdf



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