Staff Forms
Welcome to our Staff Forms page!
When submitting any of the following documents, please remember to keep a copy for yourself.
Purchase Order Information
Purchasing and Cash Handling Procedures
New Vendor Request Form (Obtain and attach their W9 form)
BLANK W9 (Need from new vendors. Return to UO)
Our Tax Exempt Letter
Our W9 Form (2016)
School Specialty Order Instructions
Staples Order Instructions
Request for Purchase Order (2020)
Check Request (2020)
American Express P-Card Expense Report (2020)
BMO Mastercard P-Card Expense Report (2020)
Questions regarding purchase orders can be directed to Hillary in Accounts Payable at 815-426-2162 or via email at houbergh@hcusd2.org.
Insurance Information / Documents
The Herscher School District is part of the Educational Benefit Cooperative (EBC).
OPEN ENROLLMENT for 2024-2025 is closed.
Should you experience a qualifying life event, please contact Payroll/HR at 815-421-5016
24-25 Insurance Rates
EBC Summary for 2024-25
EBC Admin Manual rev 10.2023
Open Enrollment Presentation from AJGallagher: https://www.brainshark.com/gallagher/vu?pi=zGizjb7G8zlAXQz0
DENTAL
BCBS Dental Benefits Highlight Sheet - LOW Plan
Dental Low Policy Document - updated 12.2.2024
BCBS Dental Benefits Highlight Sheet- HIGH Plan
Dental High Policy Document - updated 12.2.2024
HEALTH
HSA PPO Summary of Benefits and Coverage (SBC) 24-25
HSA PPO Guide
HSA Frequently Asked Questions
HSA PPO Handout
HSA Salary Reduction Agreement 2024
HSA PPO Policy Document - updated 12.2.2024
Questions about allowable expenses under the HSA? Click here for a helpful website.
HRA PPO Summary of Benefits and Coverage (SBC) 24-25
HRA PPO Handout
HRA Deductible Reimbursement Form 24-25 * Send w/ your EOB that states the amount met of your deductible to the Unit Office Attn: H. Crane
**The district does not reimburse Out-Of-Pocket expenses.**
HRA Deductible Reimbursement Form 24-25
HRA PPO Policy Document - updated 12.2.2024
Insurance Waiver 24-25 Remember you must: complete this paper waiver, waive coverage ONLINE AND submit proof of other coverage. Proof MUST have your name listed as a covered individual.
Transparency in Coverage
1557 / Non-Discrimination Communication Notice updated 12.2.2024
LIFE
Voluntary Life and Accidental Death & Dismemberment (AD&D) Plan Highlights
Reliance Voluntary Life Rates
Reliance Voluntary Accidental Death and Dismemberment (AD&D) Rates
VISION
EyeMed Benefits Sheet
EyeMed Out-Of-Network Benefits Claim Form for mailing
Choosing a Medigap Policy - A guide to Health Insurance for those with Medicare
EMPLOYEE ASSISTANCE PROGRAMS
Handout
Identify Theft Brochure
Travel Assistance Flyer
EBC MyCHoice Mobile App
MANDATED NOTICES
Women's Health and Cancer Rights Notice
CHIPRA State Premium Assistance Notice
Title IX Information
Payroll/Human Resources Documents
2024-2025 Pay Days
403b Meaningful Notice 2025
Plan Participation Guide 2025
Annual Retirement Benefit Guide 2025
403b Salary Reduction Agreement 2025
403b ROTH Salary Reduction Agreement 2025
457b Salary Reduction Agreement 2025
403b Investment Website: TSA Consulting Group - Herscher CUSD 2
Modified Rules for Catch-Up Contributions for Ages 60-63 to 403(b) and 457(b) - Effective 1.1.2025
403(b)/457(b) Plan Update - Maximum Allowable Contribution (MAC) Limits for 2025 Announced
409-A Annualized Compensation Form (CERT)
Application Signature Page
AUP Acceptable Use Policy
Bookkeeping/Payroll Form Instructions
DCFS Mandated Reporter Acknowledgment Form
Direct Deposit Form/Instructions. Must receive a hard copy. This sensitive information will not be changed via email or phone call.
Drug and Alcohol-Free Workplace. Board Policy 5:50
Employee Information Form - Must receive a hard copy. This sensitive information will not be changed via email or phone call.
Employee - First Report of Injury Form/Instructions
Extra Pay Sheet (CERT) Music Dept ONLY
Extra Pay Sheet - Certified (Non-Music) - 2024-2025SY
Extra Pay Sheet - Non-Cert - 2024-2025SY
Fingerprint Form - All Staff - - - EXCEPT bus drivers
Fingerprint Form - Bus Drivers ONLY!
Harassment and Sexual Misconduct Policy
IDES new hire reporting form
I-9 Form and Instructions - updated 8/2023
IMRF Member Information. New members can find important information about their benefits here.
IMRF Voluntary Additional Contribution Make/Change Form
Employer Cost & Participation Information (IMRF): https://www.imrf.org/en/about-imrf/transparency/employer-cost-and-participation-information
Non-Certified Staff. Irrevocable Notice of Intent to Retire. 2023-2028
Personal Day Request Form
Personnel Recommendation Form - PDF
Personnel Recommendation Form - WORD
Physical Exam Form
Standards and Procedures for Staff
Statement Concerning Employment in a Job Not Covered by Social Security
W-4 Illinois. Must receive a hard copy. This sensitive information will not be changed via email or phone call.
W-4 Federal (2024). Must receive a hard copy. This sensitive information will not be changed via email or phone call.
Click here to view latest tax tables. Click here for more information.
Questions about your federal withholding?
Click here to view 2025 method percentages for automated payroll systems
This helpful tool compares Single vs Married vs Head of Household as well as Standard vs. if the box in Step 2 (on new Fed W4) is checked.
Contract Links
PERA Overview
PERA Public Acts
FMLA
AUP - Acceptable Use Policy - Internet Access
Bloodborne Pathogen Policy
Computer Purchase Program
Extra Trip Request Form
Field Trip Policy/Forms (NEW) (PDF)
Field Trip Policy/Forms (NEW) (WORD)
HHS Overnight Trip Form
Safety Handbook for Staff
Student Transfer Form
SUB Teacher Time Report
Tenure and RIF Processes
Travel Request / Expense Report (2024)
Tuition Reimbursement Form and Info
Tutoring Reimbursement Form
Technology Department
Accessing public folders/calendars using the web
Accessing public folders/calendars using Outlook
Connecting Android devices to e-mail server
Connecting iPads and iPhones to e-mail server
Connecting your personal laptop to school email using Microsoft Outlook
Google Apps for education sign in
Link to Technology Help Desk
New online e-mail link
Setting up your web-page
Teacher Webpage Tutorial Video
Teacher/Staff request to your add personal device on wireless
Maintenance Request Forms
Activity and Facility Usage Request Form
BGS Maintenance Request Form
Custodial Request Form
Foods Maintenance Request Form
HHS Maintenance Request Form
HIS Maintenance Request Form
LMS North Maintenance Request Form
LMS South Maintenance Request Form
Special Services Maintenance Request Form
Technology Maintenance Request Form
Transportation Maintenance Request Form
Food Service Department
Lunch Count Form: https://forms.gle/ftGeXuEoi8BurxEeA