Human Resources Forms

Submit Employment Application
You may complete an online application here. You may apply for jobs 24/7.

• 2024 W-4 Form
• AD-HOC Telecommuting Arrangements
• Applicant Summary
• Authorization for Release of Information
• Cafeteria Plan Reimbursement Form
• Chronic Form
• Direct Deposit Form
• Donated Leave Form
• Employee Assistance Program
• Entry and Exit Checklist
• Flex Time Work Schedule Request Form
• FMLA Certification Form (Employee)
• FMLA Certification Form (Family Member)
• Form I-9, Employment Eligibility Verification
• Form P-1, “Request to Recruit for Employment”
• Form P-2, “Employment, Promotion or Transfer Request”
• Form P-3, “Termination of Employment”
• MSPB Grievance Form
• Health Insurance Plan Application for Coverage
• Leave Form
• MDE Contract Worker Background Acknowledgement
• MDE New Hire Packet
• MSPB handbook and acknowledgement form
• Mississippi State Tax Form
• Monthly Time Report
• Non-State Service Letter
• Physicians’ Certification for Donated Leave
• Request for Donated Leave
• Telephone Reference Check
• Telework Assignment Form
• Workers’ Compensation Packet

PERS

• PERS Beneficiary Designation
• PERS Change of Information
• PERS Membership Application

COMPLIANCE FORMS

• Fraud Waste & Abuse Policy Acknowledgment
• Code of Ethical Conduct Policy Acknowledgment
• Code of Ethical Conduct Policy for Accounting & Finance Employees Acknowledgment
• Related Party and Nepotism Acknowledgment
• Related Party Questionnaire

CONTRACT WORKER FORMS

FORMS TO BE COMPLETED BY CONTRACT WORKER

• 2024 W-4 Form
• Mississippi State Tax Form
• Certification of PERS Service Retirement The SBE must approve contracts with former state employees who are PERS retirees receiving retirement benefits for an amount exceeding $20,000 a year.
• Direct Deposit Form
• Information Change Form – Name, Address, etc.

FORMS TO BE COMPLETED BY CONTRACT WORKER AND REQUESTING OFFICE:

• PERS Form 4B (only complete if contract worker is a PERS retiree)
• Form I-9 – Employment Eligibility Verification
• Background Acknowledgement and Authorization to Release Information (with Human Resources approval) Note: If there is not a break in service from the prior fiscal year then no additional background check is required. However, if there is a break in service, then another background check is required.
• Telephone Reference Check, Please complete this form for each reference check done on behalf of the candidate.
• Certification of School District/Public Entity  (Only complete if contractor is a school district or public entity employee.)   Form to be completed by contractor and requesting office.  The form can be modified if employment is other than a school district.