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    Pocantico Hills Central School District

    Learning - Achievement - Growth - Direction

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    Human Resources

    • Human Resources
    • Human Resources Forms (Staff Only)
    • Pocantico Hills Central School District
    • Human Resources Forms (Staff Only)

    Human Resources Forms

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    • AFLAC (Flexible Spending)

      • Plan List of Benefits 
      • FSA Form
    • Benefit Forms

      • Health Insurance Enrollment Transaction Form 
      • Pre-Tax Form - Health Insurance 
      • Health Insurance Enrollment/Declination Form 
      • Life Insurance - JJStanis 
        • Request for Change of Beneficiary Form
      • 403(b)
    • CSEA

      • Universal Enrollment Form
        • Name Change Form
      • Sunrise Dental Plan
      • Sunrise Dental Enrollment Plan
      • Gold Vision Plan
    • FMLA

      • FMLA Employee Rights and Responsibilities
      • FMLA Employee Guide
      • FMLA Leave Request Form 
        • Certification of Health Care Provider for Family Member's Serious Condition (Form WH-380-F)
        • Certification of Health Care Provider for Employee's Serious Condition (Form WH-380-E)
        • Certification of Qualifying Exigency for Military Family Leave (Form WH-384) 
        • Certification of Serious Injury or Illness of Covered Service Member for Military Leave (Form WH-385) 
    • New York State Local Retirement Forms

      • NYSLRS - ERS Membership Form
      • ERS Prior Membership
    • New York State Teacher's Retirement Forms

      • NYSTRS Membership Form 
      • NYSTRS Prior Membership Form
    • Payroll Forms

      • I-9
      • W-4 
      • IT-2104 
      • Direct Deposit
      • Number of Pays per Year - 10 Month Employees
    • Other Forms

      • Cancer Screening Leave Form

    Visit Us

    599 Bedford Road

    Sleepy Hollow, NY 10591

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    Contact Us

    Phone: 914-631-2440

    Fax: 914-631-3280

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