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City of Grand Haven
City of Grand Haven
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Forms

Below are forms for employee use.  Please complete and submit to HR or Finance.

Tahlor Carlen
Send email to Tahlor Carlen
Human Resources Manager
616-847-4887
Carla Tenhove
Send email to Carla Tenhove
Payroll Accountant
616-847-4893

Injury

Blood & Bodily Fluid Exposure WorksheetInjury Flow ChartInjury Report Form


Payroll

457 Enrollment & Change FormCredit Card Authorization FormDirect Deposit Change FormFederal W-4SA Contribution Change FormIRA Contribution Change FormMI W-4Time Off Request FormOvertime Request Form

FSA

FSA Mandatory Statement for Dependent Care

Retirement

457 Enrollment & Change FormIRA ApplicationIRA Contribution Change Form

Apply for Retirement

Municipal Employees' Retirement System


FMLA

FMLA Cert For Family Member Serious Health ConditionFMLA Cert for Employee Serious Health ConditionHow to File Your Disability Claims


Tuition Reimbursement

Form 1: Submit Prior to Course StartingForm 2: Submit After Grades Received


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Grand Haven City Hall 519 Washington Avenue Grand Haven, MI 49417-1486 p: 616-842-3210

Open Monday through Friday 8:00 a.m. – 5:00 p.m.

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