Employee Forms

Job Application

Effective June 2019, all applicants for positions reporting to the Town Administrator must complete a Town of Fairhaven job application. This application must be completed in full (do not "refer to resume"). Applicants are welcome to attach their resumes and cover letters, but applications should be submitted in a single PDF document with the last name of the applicant in the file name. The application can be downloaded by clicking here.

Family Medical Leave Act:

• FMLA - Certification by Health Care Provider of Employee's Serious Health Condition
• FMLA - Certification by Health Care Provider of Family Member's Serious Health Condition
• FMLA - Notice of Eligibility
• FMLA - Designation Notice

MA Small Necessities Leave Act

• Small Necessities Leave Act language
• Small Necessities Leave form

Blue Cross Blue Shield Forms (Employee use only)

• HMO Summary of Benefits
• PPO Summary of Benefits
• Medex Summary of Benefits
• Medex - Prescription Drug Plan
• Dental Blue Summary of Benefits
• BCBS Enrollment/Change Form
• Insurance Rate Sheet 10/01/23 to 6/30/24
• Gym Membership Reimbursement Form

Employee Payroll Forms 

• Direct Deposit Authorization Form 
• MA Withholding Certificate Form M-4 
• Federal WIthholding Certificate W-4
• W-2 Request