Welcome to Lynnfield Public Schools Employment Site
All new hire forms are on the links to the right. Please select the correct box for your position.
IMPORTANT: These forms are fillable on your computer. Please follow the following instructions:
Download the form to your computer
Click to open the form and fill in all information
Print the filled in form
Sign and forward to:
Linda Call - Payroll, Benefits, Employment
Address: 525 Salem Street (Rear) Lynnfield, MA 01940
Contact: Phone: (781) 334-9212 Email: firstname.lastname@example.org
Important Information about change in status:
Qualifying Events that may be used to request a change in status:
- Open Enrollment
- Marriage, Divorce, Annulment
- Death of Spouse/Dependent, birth, adoption, or placement for adoption of dependent
- Beginning/ending of employment of spouse/dependent (including strike or lockout)
- Change in eligibility/ineligibility of dependent (such as age, marriage, enlisting in military)
- Full-time to part-time employment or part-time to full-time
- Acknowledgement, judgement, decree, or order to cease/provide coverage for a child
- HIPAA Special Enrollment (when you acquire a dependent through marriage, birth, or adoption and apply for valid Change of Status within 30 days of qualifying event-you may be able to add eligible dependents
- Medicare/Mediaid (gain or loss of eligibility)
- Change in residence or work place (the change must affect your eligibility for coverage-example - you cannot drop health coverage merely because you move unless as a result of move, you are no longer eligible for particular health benefit or you no longer reside with your provider network)
- Spouse's annual enrollment changes (you may request election changes to correspond with changes made by your spouse during his/her annual enrollment. You must provide proof that the changes were made; you can make changes only to those elections affected by your spouse's changes; and your election changes cannot be effective prior to the effective date of spouse's changes.)
Please NOTE (and plan accordingly):
The Dependent must be added withing 60 days of date of the qualifying event.
GIC Insurance will not add the new dependent after 60 days. After the 60 days the dependent must wait until the annual open enrollment period.
Altus Dental has a deadline of within 30 days after the qualifying event. After 30 days the dependent must wait until the annual open enrollment period.