The following embedded form can be printed. You can make your choices, sign, date, and fax back to the HR Department at 330-478-0140.
You can make your choices on this form and easily submit to HR.
THIS MUST BE RETURNED TO HR BY MAY 23rd
By signing below, I understand that the above payroll deductions will be deducted from my pay beginning with first payroll in June 2020. These rates will be guaranteed for 1 year unless I make a coverage change throughout the year.