Benefits Paper Forms
If you are unable to complete your enrollment electronically due to technology or other limitations, you have the following two options:
1 - Use the shared onboarding computer station or another available computer at your facility (with your Supervisor's permission). Onboarding station computers are generally located in your facility lobby.
**Shared computer stations must be cleaned before and after each use**
2 - Complete and submit paper forms, which can be downloaded below. Any submitted paper forms MUST BE RECEIVED BY HR by 5pm on the date of the deadline, and need to be scanned to DOCS4HR by your supervisor. Paper forms should not be put in the interoffice mail.
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BE ADVISED if you are using a public or shared computer or device, you NEED TO LOG OUT of your personal ADP account when you are finished to maintain confidentiality of your personal information. ADP will automatically log you out after a period of inactivity, but don't rely on this feature to protect your privacy.
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REQUIRED FORMS IF YOU ARE UNABLE TO ENROLL ONLINE
Please enroll within 7 days of your hire date. Enrollment must be completed within 31 days of your hire date or qualifying event date. If you are unable to enroll online, forms can be scanned to HR at the main office copier of your location (look for DOCS4HR on the scanner) or given to your Supervisor. If you have the ability to scan the forms with your own technology, you may also email scanned copies to HR@kleentest.com.
*Note - Changes from qualifying events will always need to be done with paper forms submitted to HR.
Printed copies are available outside the HR office (or in the front office) at each location.
Not completing your enrollment may result in disciplinary action, as some responses are required to be complete for each employee.
KTP Benefits Forms - Cover Sheet & Checklist.pdfBenefits Paperwork Checklist
Review this list to see which forms you need to submit. Some are required, so make sure you read it carefully!
KTP Benefits Forms - FORM B9B - Life Insurance Beneficiary Form.pdfLife Insurance Beneficiary Form
This form is required for all employees. The company provides life insurance coverage equal to your annual salary, effective the first of the month following 30 days of active employment.
Note - If you are electing to waive (not take) medical insurance, you are REQUIRED to return a waiver form with reason for waiving.
KTP Benefits Forms - FORM B2 - Medical Waiver .pdfMedical Waiver
REQUIRED IF YOU DO NOT ENROLL
KTP Benefits Forms - FORM B1 - Medical Enrollment.pdfMedical Insurance Enrollment
KTP Benefits Forms - FORM B3 - Affidavit for Participation in the Tobacco-Free Incentive Plan.pdfTobacco-Free Incentive Affidavit
(Qualified employees MUST return this form in order to avoid paying the higher rates without the tobacco-free incentive discount.)
KTP Benefits Forms - FORM B5 - Dental Enrollment.pdfDental Insurance Enrollment
KTP Benefits Forms - FORM B6 - Vision Enrollment.pdfVision Insurance Enrollment
KTP Benefits Forms - FORM B4 - Spousal Medical Coverage Statement.pdfSpousal Surcharge Coverage Statement
(If your spouse is on your plan, this form is REQUIRED to determine whether you qualify to avoid the surcharge.)KTP Benefits Forms - FORM B7 - Flexible Spend FSA Enrollment with PPO Only.pdfOptional Flexible Spending Account Enrollment (Health Care or Dependent Care)
May only be used with PPO Medical Plan - MORE INFO HERE
KTP Benefits Forms - FORM B8 - Health Savings HSA Enrollment with HDHP Only.pdfOptional Health Savings Account (HSA) Enrollment
May only be used with HDHP Medical Plan - MORE INFO HERE
Here is a list of all benefits forms, so you can click and download the forms you need in one easy location (click and open Google Drive to download).
B1 - Medical Enrollment (you will also need B3)
B2 - Medical Waiver
B3 - Tobacco-Free Incentive Affidavit
B4 - Spousal Coverage Statement
B5 - Dental Enrollment
B6 - Vision Enrollment
B7 - FSA Enrollment
B8 - HSA Enrollment
B9B - Life Insurance Beneficiary Form
QUICK LINKS to Other Benefits Information
Still need help?
If you have other questions, click the button below to email HR.