Forms

• Change of Address Form
  This form will update payroll, benefits, and your employee record with your new address. If you have changed your name, please contact payroll and provide documentation showing a legal name change.
• Direct Deposit Form - contact payroll
• Flexible Spending Plan forms
• Form W-4 (PDF) (federal taxes)
• Form M-4 (PDF) (state taxes)
• Leave Request Form

Forms for your health insurance fitness reimbursement and mail order prescriptions can be found on our Employee Discounts Page.

If you need additional forms to update your benefits, check the Benefits Page or contact the Treasurer's Office at 781-270-1623.

Family / Medical Leave (FMLA)

If you will be out to care for a family member or for your own serious health condition, you may be eligible for job protections through the Family Medical Leave Act (FMLA) (PDF). To qualify for this leave you must have been employed in Burlington for at least 12 months an have worked a minimum of 1,250 hours in those previous 12 months.

Submit these forms to Human Resources to assist us in providing this benefit to you. All materials will be maintained confidentially and may be faxed to 781-238-4696.

• Employee Request Form
  • Healthcare Provider Certification Form (PDF) - for an employee's health condition (right click on link and select "save link as..." to save it to your documents folder)
  • Healthcare Provider Certification Form (PDF) - for a family member's health condition (right click on link and select "save link as..." to save it to your documents folder)
• FAQs for Town Employees (PDF)
• FAQs for School Employees (PDF)
• FAQs from the Department of Labor

When you return, you will need to provide a note from your doctor letting us know that you are cleared to return to work. If you are released to work with accommodations, we will need to know that as well in order to determine if those requests can be put into place. For your convenience, you may provide the Fitness for Duty Certification and Notice of Intent to Return to Work (PDF) for your doctor to complete.

Small Necessities Leave

The Small Necessities Leave Act allows employees who qualify under the federal Family and Medical Leave Act (above) to take off up to 24 hours of job protected leave in a 12 month period for:

• your child's school activities, such as parent-teacher conferences
• your child's medical appointments
• your elderly relative's medical appointments or appointments for other professional services related to the elder's care, such as interviewing at nursing or group homes (elderly relative is defined as a family member over 60 years of age related to you by blood or marriage).

You may use any of your accrued leave for this purpose. Submit this request form to Human Resources at least seven days prior to the beginning of your leave.