For City Employees
COVID Policy Related-Forms
- COVID-19 Safety Protocols (sign this form online)
- COVID-19 Vaccine Attestation – three formats
- Fill-in form online with option to upload scan or photo of vaccine card
- PDF to download and print. In addition to completing the form, bring your vaccine card to the HR office, or email a scan or photo of your card to loric@takomaparkmd.gov.
- Attestation without documentation (complete this form online)
- COVID-19 Medical Accommodation Request (download and print PDF and share with your doctor)
- COVID-19 Religious Accommodation Request (complete this form online)
Other Forms
- Direct Deposit Enrollment (complete this form online)
- Employee Alert Sign Up (complete this form online) to add your personal cell phone or email address to receive employee alert notifications
- Emergency Contact Form (complete this form online)
- Employee Change Request form (complete this form online) to submit changes in address, phone number, or name
- Exit Interview (complete this form online)
- Multilingual Certification (complete this form online)
- Reasonable Accommodation (to download and print)
- Telework Eligibility Checklist & Agreement (to download and print)
- Transfer Request (complete this form online)
- Tuition Support Request (to download and print)
- Employment Eligibility Verification (I-9)
Family and Medical Leave Act (FMLA) Forms
- Employee Rights Under the Family and Medical Leave Act
- Certification of Health Care Provider for Employee’s Serious Health Condition
- Certification of Health Care Provider for Family Member’s Serious Health Condition
- Certification for Serious Injury or Illness of Current Servicemember for Military Family Leave
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
- Certification of Qualifying Exigency for Military Family Leave
Tax Forms
- Federal Withholding (W-4)
- Maryland Withholding (MW-507)
- DC Withholding (D-4)
- Virginia Withholding (VA-4)
Benefit Forms
For enrollment and change forms, as well as detailed descriptions of employee benefits, see the Employee Benefits page.
Employee Assistance Programs
Employee Assistance Programs (EAP) are resources available to help employees through stressful situations and events. These are third-party resources, and use of them is never reported to the City. EAP support is available 24/7, 365 days a year.
Every City employee has access to an Employee Assistance Program (EAP) for yourself, your eligible dependents, and anyone living in the same household. EAP is offered through Assistance by BHS, Mutual of Omaha, and Optum/United Healthcare. Specific information for each plan is provided below.
- Available to all employees and their household members at no cost.
- Eligible to receive up to 4 short-term problem resolution sessions per issue, per year.
- Available 24 hours a day, 7 days a week via toll-free number 800-327-2251.
- Provides information and referral resources.
- Confidential emotional support.
- Available to benefit-eligible employees and their eligible dependents at no cost.
- Available 24 hours a day, 7 days a week via toll-free number 800-316-2796, or online at mutualofomaha.com/eap
- Provides information and referral resources.
- Confidential emotional support.
- Available to UHC members and covered dependents at no additional cost, unless referred to a physician where co-pays would apply.
- Available 24 hours a day, 7 days a week via toll-free number 1-866-342-6892
Quick Links
- Careers with Takoma Park
- FY22 Salary Range Tables
- 2022 Payroll Calendar
- Forms and Resources for City Employees
- Employee Benefits
- Personnel Policies
- Collective Bargaining Agreements
Pay Information, Tax Info & Contact Info
Payroll/Holiday Calendar
Employee Self Service
Employee Self Service (Tyler)
Employees may use this link to:
- access current pay information beginning in 2015
- access W-2s beginning with the 2015 tax year
- calculate paychecks
- review phone number, address, and emergency contact information on file
- setup tax exemptions
Historical information can be found in the Employee Access Center.
How to log in: To log in to the Employee Self Service site, please enter your user name and the last 4 digits of your social security number. Your user name is the name you use to sign on to the City’s network and your e-mail.
Employment Separation Resources
Before your last date of employment, be sure to turn in your Staff badge and any City equipment in your possession to your supervisor or department head, and complete the Exit Interview form, below. Questions about benefits can be answered in the documents below, or by contacting humanresources@takomaparkmd.gov.
- Employment Separation Policy
- Employment Separation FAQ
- Separation Benefits Information
- Exit Interview (Complete online)
- 457 Deferred Compensation Benefit Withdrawal Form
- Maryland State Retirement – Withdrawal of Accumulated Contributions
Performance Management
SuccessFactors Performance Manager
SuccessFactors is used for performance management as well as internal recruiting. Use this link above to access your performance evaluation form and update goals for the performance period.
Employees may also use this site to review and apply for positions internally.
