Payroll and Benefit Information

Below you will find a list of employee forms, benefit, payroll, and employment information.
For the convenience of Springfield School District employees, several forms are now available to print from this page and through the links attached to this page, in PDF format. Please call the Central Office with any questions. Thank you.
(to be completed by all employees new to the district):
Please print, complete, and send to the School or Department to which you are applying.


Springfield School District values its employee community and has put together a comprehensive, affordable benefits package that is designed to support your physical, financial, and emotional well-being. Choose from the links below to learn more.
Please contact Human Resources for questions or additional information on any of the benefits listed herein at 802-885-5127 or [email protected]. Thank you.
Calendar Year Support Staff
School Year Support Staff
Flexible Spending Account (FSA)
Dependent Care Account (DCAP)
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA) – (Non-Union Employees Only)

– Enrollment/Change form
– Waiver of Coverage form
– Outline of Coverage by employee type
– HOW (Health through Oral Wellness) information
– Vision Discount information

Beneficiary Change/Designation form
Privacy Notice
Life Certificates by employee class
Long-Term Disability Certificates by employee class
Short Term Disability Certificates by employee class

403(b) Annuity Plan (Pre-tax & Post-tax options) –
Contact information
Contribution Change form
Beneficiary Designation/Name & Address Change Form
The Health Insurance and Portability and Accountability Act of 1996 (HIPAA); page 1
Continuation Coverage Rights Under COBRA; pages 1-3
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP); pages 4 – 6
Women’s Health & Cancer Rights Act of 1998; page 6
Newborns’ and Mothers’ Health Protection Act of 1996; page 7
Important Notice About Your Prescription Drug Coverage and Medicare; pages 7 – 8
Health Care Reform: General Information
Summary of Benefits and Coverage (“SBC”) and Uniform Glossary; page 8
Notice Regarding the Health Insurance Marketplace; pages 8 – 9


Direct Deposit form
W-4 Federal
W-4 VT – NEW 2019
Pay period dates

School Year Absence Day Guidelines before/after school breaks

Hourly employee time card guidelines

Communication from Supt McLaughlin re:
Exceeding absence days (all employees)
Appropriate use of Floating Holiday & Vacation days (Calendar year employees covered by SSSA Master Agreement)

Request for Leave of Absence form (all employees must complete this form for an absence of 5 or more days)
Teacher Absence Leave Bank Request form
– Family Medical Leave Act (FMLA)
– Vermont Parental Family Leave (VPFL)