Forms

Arizona

Arizona New Hire Packet 2012
Paperwork required for each new employee you hire. Please complete and send back to your Trigon rep.

A4 Tax Form 2012

This form must be completed and submitted in addition to the standard A4 Tax Form 2011.

W4 Tax Form 2012
This form is used by employers to determine the correct amount of federal withholding tax to deduct from employees' wages.

I9 Form 2010
The I-9 is a U.S. Citizenship and Immigration Services form. It is used by an employer to verify an employee's identity and to establish that the worker is eligible to accept employment in the United States.

Authorization for Direct Deposit
Form to provide authorization from the employee which will allow Trigon to deposit their check directly into their banking institution of choice.

Auto Debit Authorization Form

Cash Advance Deduction Form
Form which authorizes the advance of funds to an employee from a Trigon employer.

Employee Deduction Authorization
Form to authorize deductions made from an employees paycheck.

Employer's Report of Industrial Injury
Form to complete once an injury has occurred at the jobsite. The employer will complete the form and send to their Trigon rep.

Notice of Employee Change
Form completed by the employer to provide notice to Trigon of any change in status of an employee.

Notice of Termination
Form completed by the employer to provide notice to Trigon upon the termination of an employee.

Workers' Compensation Certificate Request
Notice provided to Trigon in order to request a Workers' Compensation Certificate to serve as proof on insurance.

Arizona Quote
Detailed Profile on Client Company which will allow Trigon to produce an accurate quote for services.

New Mexico

New Mexico New Hire Packet 2011
Paperwork required for each new employee you hire. Please complete and send back to your Trigon rep.

New Mexico Workers' Compensation First Employer Report of Injury
Form to report all alleged work-related injuries or illness resulting in more than 7 days of lost work or in death of a worker.

Utah

Utah New Hire Packet 2012
Paperwork required for each new employee you hire. Please complete and send back to your Trigon rep.This is the header graphic that will be displayed across the top of the page.