Forms
- Accounts Payable Forms
- Benefits Forms & Instructions
- Employee Separation Form
- Employee Status Change Form
- Facilities Rental Forms
- Fixed Asset Forms
- Fundraiser Forms
- Leave of Absence Forms
- Payroll Forms
- Print Shop Forms
- Risk Management Forms
- Travel Forms
- Sick Leave Bank Forms
Accounts Payable Forms
Code Correction Form (updated 10/22/2021)
Deposit Correction Form (updated 4/14/2021)
Interdepartmental Transfer
Intouch Revised Deposit Form (updated 10/14/2020)
Waived Fee Form
Benefits Forms & Instructions
Claim Forms & Instructions
Accident and Critical Illness (The Standard)
Accident Benefits Claim Packet
Critical Illness Benefit Claim Packet
Health Maintenance Screening Benefit
Group Accident Insurance Certificate
Group Critical Illness Insurance Certificate
Cancer Insurance (Loyal American)
Disability Insurance (The Standard)
Short Term Disability FAQ about Filing a Claim
(Claims after 9/1/21)
Long Term Disability FAQ about Filing a Claim
(Claims after 9/1/21)
Hospital Indemnity (Standard) Effective 4/1/23
Health Maintenance Screening Benefit
Forms and Instructions for Name and Beneficiary Changes
Other Forms
Health Insurance Forms
Disabled Dependent Certification form
HIPAA
Benefit Change Form
Benefit change form
- Complete this form to make an Approved Section 125 Change to your benefits.
- Birth or Adoption of a child
- Marriage or Divorce that results in loss of other coverage
- Court Ordered coverage
- Death of spouse or dependent
- Involuntary loss of coverage
- Employee or dependent gains coverage elsewhere
- Change in dependent status
- Payroll change is effective 1st of the month following the request is received in the Benefits Office.
- You must COMPLETE and submit all forms and documentation within 31 days of the event in order to make changes.
Mesquite ISD Cancellation Request
Mesquite ISD Cancellation Request Form
- Complete this form to stop your
- Annuity (403b, 457) contribution
- Lone Star 529 Plan contribution
- Auto/Homeowners insurance
- Accident Insurance
- Critical Illness insurance
- Accidental Death and Dismemberment insurance
- Texas Life Permanent Life insurance
- Standard Term Life insurance policy
- Payroll change is effective 1st of month following date request is received in Benefits Office.
The Standard Insurance Forms
- Complete this form if you wish to obtain or increase life insurance coverage during a benefits open enrollment opportunity.
- Select your State of Residence and Language Preference (English or Spanish).
- Name of Group: Mesquite ISD
- Group Number: 648015
- Type of Application:
- Initial (DO NOT SELECT THIS OPTION during an open enrollment opportunity; this option is for NEW HIRE enrollment)
- Increase in Coverage (if you are increasing your current life insurance amount more than $10k or over Guarantee Issue Amount)
- Late Application (if this is your initial enrollment for life insurance)
Employee Separation Form
Employee Status Change Form
Instructions for Completing Employee Status Form
Important note: you must have Adobe Acrobat Reader installed on your computer to complete the necessary digital signatures on this form. Adobe Acrobat and Ereader will not support the digital signature. You will not be able to complete the signature portion on the document without Adobe Acrobat Reader.
This document must be completed and submitted electronically. You may not print and scan the document. If you do not have Adobe Acrobat Reader you will need to submit a request to install the program to help desk.
This form is NO LONGER for any type of employee separation. See above for new Employee Separation Form.
It is also NOT for Name Changes – use this form for name changes.
- Download and Save the form to your desktop or preferred folder
- Open the form in Adobe Acrobat Reader
- Complete all the blue fields at the top of the form and make sure you complete the "Replaces" and "Effective Date of Change" fields. Pink fields are optional. All YELLOW and GREEN Fields are for Personnel use ONLY. Employee Signature is optional. Supervisor Digital Signature is REQUIRED.
- Once the form is complete and digital signature is added, save the form to your desktop or preferred folder as: "employeename_StatusChangeForm_date"
5. EMAIL the form to the appropriate personnel director:
- Paraprofessionals - Kellie Haddock
- Elementary Professionals - Larry Sanford
- Secondary Professionals - Emilio Duran
- Auxiliary - Kyle Holcomb
Click the following button to download the electronic, fillable Employee Status Change Form.
Facilities Rental Forms
Fixed Asset Forms
Fundraiser Forms
Leave of Absence Forms
Leave of Absence
A leave of absence request must be completed if an employee will be absent for 5 or more consecutive days. The request for a leave of absence should be completed and submitted using the Mesquite ISD Request for Leave form.
A physician’s statement is required for leave approval. You may upload the documentation in the google form request or email or fax a copy of your physician's statement to Rhonda Ferrin in Personnel Services.
Email: RFerrin@mesquiteisd.org
Fax: 972-882-7799
*Your leave request will NOT be approved until you have submitted your physician's statement.
Payroll Forms
W-4 Form (IRS Website)
Direct Deposit Form
Credit Union of Texas Payroll Deduction Authorization
Absentee Report
Elementary Teacher Subbing
Elementary Para Covering Class
Middle School Teacher Subbing
Middle School Para Covering Classes
High School Teacher Subbing
High School Para Covering Classes
Department Extra Duty Sheet
Print Shop Forms
Risk Management Forms
ADA Request (Updated October 2022)
Employee Acknowledgement Form ENG(added 7/24)
Employee Acknowledgement Form SPA (added 7/24)
First Report of Injury ENG (updated 5/23)
First Report of Injury SPA (updated 5/23)
First Report of Injury Written Statement ENG (added 7/22)
First Report of Injury Written Statement SPA (added 7/24)
Work Injuries and How to Report Them (added 7/24)
Vehicle Accident Report (Updated 10/22)
Travel Forms
Sick Leave Bank Forms
Should a Sick Leave Bank (SLB) member have an eligible medical event, the application and request process must be completed at least ten (10) calendar days prior.
An unanticipated medical event application and request process must be completed within ten days after the qualifying emergency.
All three required documents must be submitted to the Personnel Office within this ten-day period without exception.
After your Physician completes the Physician's Statement Form and you fill out the SLB request form, you must bring both forms to the Personnel Office and fill out a HIPPA Authorization for Release form.
Request for Sick Leave Bank Days
Attending Physician's Statement
Catastrophic illness or injury is a severe condition or combination of conditions affecting the mental or physical health of the employee that requires the services of a licensed practitioner for a prolonged period of time and that forces the employee to exhaust all leave time earned by that employee and to lose compensation from the district. Such conditions typically require prolonged hospitalization or recovery or are expected to result in disability or death. Conditions related to pregnancy or childbirth shall be considered catastrophic if they meet the requirements of this paragraph.