Forms
- Employee Information Form
- Form I9 (Must download and open with current Adobe Reader)
- Form I9 Instructions
- Form I9 Supplement
- Direct Deposit Form
- Form SSA-1945
- Voluntary Self-ID Form
- Voluntary Self-ID of Disability
- MA Family Disclosure Form
- CORI Acknowledgment & Authorization Form
- OBRA/PST Acknowledgement Card
- OBRA Withdrawal From
- Residency Ordinance Form
- Form W-4
- Form M-4
- Work Capacity Form
- CORI Release (Minor)
- Summary of the Conflict of Interest Acknowledgement Form
- Fitness Reinbursement Form
Leaves
Family Medical Leave of Absence (FMLA)
Eligibility
To be eligible for coverage under the FMLA, an employee must have worked for the City for at least 1,250 hours during the preceding twelve (12) month period. In other words, the hours of service requirement will be met if an employee has worked a total of 1,250 hours of service in the twelve (12) months immediately preceding the start of the FMLA leave. In determining whether an employee has met the 1,250 hours requirement, it is important to note that:
- Only the time actually worked, including overtime hours worked, is counted. Time not actually worked, including vacation, personal leave, sick leave, holidays, and any other form of paid time off (PTO), is not counted towards the 1,250 hours of service. Unpaid leave of any kind or periods of layoff are not counted.
- Time worked as a part-time, temporary, or seasonal employee counts toward the requirement.
- An employee returning from fulfilling a USERRA-covered military service obligation is credited with the hours of service that would have been performed but for the period of military service. The employee’s pre-service work schedule can generally be used for calculations to determine hours that would have been worked during the period of military service.
The forms listed below are now required so that we may determine if any related absences may be designated as FMLA leave. Failure to submit the required completed and signed forms may delay or prevent leave approval.
Please complete and submit this form thirty (30) days prior to your requested leave OR as soon as practicable if your leave is of an unplanned, emergency nature. This form must also include your Department Head’s signature acknowledging that they were informed of the request for leave and verify your accrued leave balances, if applicable.
This form must be completed to avoid any issues related to your insurance coverage. A completed and signed form is required, even if you do not participate in any City insurance programs.
- Certification of Health Care Provider for Employee and/or Family Member’s Serious Health Condition
This certification form must be given to your physician (or to your eligible family member’s physician) for completion. Your physician shall submit the completed forms directly to the Human Resources Director via fax, email or US Mail.
This form must be completed by you and your physician. Your physician shall submit the completed forms directly to Human Resources via fax, email or US Mail no later than three to five (3-5) business days prior to your return to work. This form is NOT required if you are on FMLA leave for a family member.
Below are the Certification Forms relative to the requested leave which must be completed and faxed directly to Human Resources:
WH-380E Employees Serious Health Condition
WH-380F Family Members Serious Health Condition
WH-384 Certification for Military Family Medical Leave
WH-385 Certification for Serious Injury or Illness of a Current Service Member
WH-385-V Certification for Serious Injury or Illness of a Veteran
Certification of Adoption or Foster Care Placement
All forms should be completed and returned directly to Human Resources within 30 (thirty) calendar days of the first day of your leave with the exception of the Health Care Provider Form which is to be returned at least fifteen (15) calendar days upon receipt.
Failure to provide the required documentation in a timely manner may result in delay or denial of requested leave.
Fact Sheet #28D Employee Notification Requirements under the Family Medical Leave Act
Court Leave (Jury Duty)
Eligible employees may receive regular salary when called to serve for jury duty or act as a witness on behalf of a governmental body. The appropriate court document and/or jury duty notice must be submitted to the Human Resources Department.
Military Leave
Paid military leave is granted to eligible employees called to duty in the armed forces of the commonwealth in the event of natural disaster or civil disturbance; unpaid leave for extended periods of active duty. Please see FMLA for Military Family Leave.
Bereavement Leave
Eligible employees may take bereavement leave depending on the relationship to the deceased. Please see your respective Collective Bargaining Agreement or Code of Ordinances (Sec. 2-136. - Funeral leave).
New Hire Forms
In order to get to a smooth start Human Resources requires new employee to complete and submit a number of documents that identify you as an employee of the City of Brockton.
All new employees must acknowledge and complete the attached pre-employment paperwork. If competed on-line, print, sign and return to Human Resources, Brockton City Hall, 2nd Floor.
There are two sections that would need to be completed and acknowledged:
Pre-Employment Packet
City of Brockton New Hire Policy Packet
Benefited appointees must also complete mandatory benefits paperwork. Please contact Human resources at 508-580-7820 or [email protected] to schedule an appointment.
Download entire Benefited Pre-employment Packet
Download entire Non-Benefited Pre-Employment Packet
NOTE: All pre-employment documents including the Form I-9 must be printed single-sided. All documents listed on the pre-employment checklist and the Form I-9 must be submitted as a complete packet in order to be processed. Faxed or scanned documents will not be accepted.
Forms included in the packets:
- Employee Information Form
- Form I9*
- W4 Federal Tax Form
- Direct Deposit Form
- Form SSA-1945 (benefitted only)
- Voluntary Self-ID Form
- Voluntary Self-ID of Disability
- MA Family Disclosure Form
- Conflict of Interest Requirements
- Notice of Residency
- CORI Acknowledgment & Authorization Form
- OBRA Acknowledgment Card (non-benefitted only)
*Newly hired employees must complete Section I of this form no later than their first date of employment. Employees must provide documents within three (3) days of their date of hire.
Complete, sign and date the bottom of the form.
Note: For further instructions on how to complete the Form I9, click on the following link:
Form I9 Instructions
If you need to download a specific form that is included in the packet please go to our “Forms” page.
POLICIES INCLUDED IN NEW HIRE PAPERWORK
Employees must sign and acknowledge receipt of City of Brockton policies and return to Human Resources along with the complete Pre-Employment Paperwork.
Download entire New Employee Policy Packet
Download Employee Policy checklist only
Policies included in the packet:
- MA CORI Policy
- Drug and Alcohol Policy
- Employee Assistance Program
- Family Medical Leave Policy
- MA Pregnant Workers Fairness Act
- Nepotism Policy
- Sexual Harassment Policy
If you need to reference or download a specific policy please go to our “Policies & Guides” page.
All documents and policy acknowledgement page must be completed and returned to Human Resources within two weeks of offer or as soon as possible to alleviate any disruption in payroll.
Policies
Policy Name | TYPE | SIZE | DOWNLOAD |
---|---|---|---|
Acknowledgement Form COI | 61 KB | Download | |
Background Check Policy | 309 KB | Download | |
Code of Ethics | 116 KB | Download | |
CORI Policy | 418 KB | Download | |
Domestic Violence Policy | 258 KB | Download | |
Drug and Alcohol Policy | 336 KB | Download | |
Employee Assistance Program | 124 KB | Download | |
Equal Employment Opportunity | 151 KB | Download | |
Family Medical Leave | 169 KB | Download | |
Fire Drug and Alcohol Policy | 132 KB | Download | |
Fire Sexual Harassment Policy | 160 KB | Download | |
Guide Public Employees | 62 KB | Download | |
Massachusetts Pregnant Workers Fairness Act | 134 KB | Download | |
Nepotism Policy and Disclosure Statement | 421 KB | Download | |
Policy for Access and Use of Telecommunications Equipment | 123 KB | Download | |
Residency | 284 KB | Download | |
Sexual Harassment Policy | 162 KB | Download |
Training and Development
Residency
Every person first employed by the City of Brockton on or after the first day of January, 1992, shall be a resident of the city or shall, within one (1) year after such person commences to be employed by the city, establish residency within the city.
Failure of an employee to establish residency within the City of Brockton within one (1) year after commencement of employment with the city shall be determined to be a voluntary termination of employment by such employee.
Upon taking employment with the city, and annually on July 1st thereafter, every employee shall file with his or her department head, or like officer, a certificate signed under the pains and penalties of perjury, stating his or her name and place of residence.
If you need to download the residency requirement please visit our Policy & Guides page.
Work Life
Employee Assistance Program (EAP)
AllOne Health
Provides a wide range of assistance services that help increase individual, student, member and organizational health & productivity. AllOne Health provides a level of 24/7 concierge-style services that sets the standard, along with in-person and online resources that encourage you to maintain health and positive lifestyles – while supporting them with proven, effective strategies when needed.
Services provided but not limited to:
Mental Health CounselingLife Coaching
Work/Life Resources
Student Assistance Program
Legal/Financial Resources
For more information and/or contact a representative:
Telephone: 1-877-720-7770
Email: [email protected]
Website: allonehealth.com
Massachusetts Legal Holidays
For a full description please click below:Massachusetts Legal Holidays 2019 - 2021
Job Aids
Union Contracts
The Human Resources Department serves as the City's chief representative in all employee relations matters, including collective bargaining. Human Resources provides guidance on a wide variety of employment issues and concerns with the goal of ensuring the fair and consistent treatment of all City staff. Each bargaining unit has a collective bargaining agreement (CBA); Please see the links below to review your respective CBA. Note, if your contract is not listed, please contact your union representative to a receive a copy.