Downloads

Business Office Forms

Please click on the forms below to open and download it.

Time Sheet
Mileage Reimbursement
Background Check Process
Background Check Link
Driver Application Form
Volunteer Driver Application Form
Accident and Incident Investigation Report
Employee’s Notice of Injury
Check Request for Reimbursements
Phone Extension List – 8.5×11
Staff Action Request (SAR- open positions)
Childcare Reimbursement Form
Prizes, Gifts & Awards Form
Payroll Change Notice (PCN – employee hired)
Payroll Change Notice (PCN – childcare workers only)

New Hire Forms

Cross Church Payroll Change Notice
Cross Church Payroll Change Notice (childcare workers only)
Cross Church Payroll Deposit (ACH)
AR4EC
W-4 Form
I-9 Form
W-9 Form
Job Description Draft
Shiloh Payroll Deposit (ACH)
Underage Volunteer Reference Form

Benefit, Health, and Retirement Forms

Please click on the forms below to open and download it.

2025 Open Enrollment

Health Insurance Change Form
HC1000 Benefits Overview
HC1000 Summary of Benefits
HC2500 Benefits Overview
HC2500 Summary of Benefits
VH5000 Benefits Overview
VH5000 Summary of Benefits
CHIPRA Required Notice
HIPPA Notice of Privacy Practices
403b Retirement: Annual Notification of Automatic Deferral

Dental Summary of Benefits
CC Dental Change Form
SCS Dental Change Form

EyeMed Summary of Benefits
CC EyeMed Change Form
SCS EyeMed Change Form

Voluntary Life Benefits & Rates
Voluntary Life Form

BestFlex (FSA) Plan Summary
FSA Online Enrollment instructions
FSA Enrollment Form

Benefit Websites & Apps

Insurance Websites & Mobile Apps

Delta Dental

Delta Dental CC & SCS Enrollment Form
Delta Dental CC & SCS Summary of Benefits
Delta Dental CC & SCS Certificate of Coverage

EyeMed

Eye Med Summary of Benefits
Eye Med CC Enrollment Form
Eye Med SCS Enrollment Form
EyeMed FAQ’s
EyeMed Mobile App
Eye Med Online Access

HighMark Health

Guidestone Health Benefits Booklet
Glossary of Health Coverage & Medical Terms
Special Enrollment Form (Qualifying Event)
Request for Medical Continuation
Waiver of Medical Coverage
My QHealth
My QHealth Q&A
Wellness Tools & Additional Benefits

FSA – Flex Spending Account

FSA Year End Claims
Benefits Card Flyer
Eligiable Expense List
FSA Enrollment Guide
FSA Participant Worksheet
FSA Summary Plan Description
FSA Rollover Brochure

Life – Voluntary, Whole, Term

Life Enrollment
Term Life Benefits
Voluntary Summary of Benefits
Long Term Disability Benefits
Long Term Disability Summary
Mutual of Omaha Voluntary Premium Sheet
Beneficiary Form

Retirement – 403b

403b Quick Enroll Cross Church
403b Quick Enroll SCS
403b Beneficiary Form
403b Plan Summary
Retirement Contribution Agreement

Transportation Forms

Please click on the form title below to open and fill out the electronic form.

Pre-Trip Reports

Shuttle PRE-Trip Inspection Report
Bus PRE-Trip Inspection Report

Post-Trip Reports

Shuttle POST-Trip Inspection Report
Bus POST-Trip Inspection Report

Other Forms

Please click on the form below to open and download it.

Member Assistance Checklist and Assessment Tool
Training video on how to fill out a Decision Form
Decision Form
Membership Covenant
Decision Form | Spanish
Membership Covenant | Spanish