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Grievance Forms

Statement of Occurrence

Information Request Form

Grievance Form AT&T Mobility

Grievance Form IGT

Grievance Form PPA

Grievance Form USIC

Grievance Form Verizon

PPA Forms

PPA Membership Application & Payroll Deduction

PPA Steps to Verify Days

Verizon Forms

Regional Work and Family Program forms 2024

Work and Family Initiatives overview 2024

Dependent Care Application 2024

Dependent Care Monthly Reimbursement Form 2024

Defensive Driving Reimbursement Program 2024

Educational Reimbursement (college books and materials) 2024 increased

Health and Wellness Program (incl gym reimbursement) 2024 increased

High School Driver Education (2024)new

Pendant Program Application (2024)

Pendant Program Quarterly Reimbursement Form (2024)

Summer Camp Flyer (2024) increased

Summer Camp Application (2024)

Tutoring Reimbursement (2024) new


Anticipated Disability Form Verizon

Payroll Action Form Verizon

Sedgwick Attending Physician Statement Behavioral Health

Sedgwick Attending Physician Statement

Sedgwick Appeal Request Form

NOTE: FMLA forms are now sent directly from Sedgwick, upon initiation of a claim.  The reporting process remains the same, beginning with a call out to your supervisor or absence administrator. 



Change of Address

Employer Unfair Labor Practices

Prudential Beneficiary Form Jan 5, 2022

(please fill out, sign and return to CWA Local 1101, Atten: Kevin Condy, 350 West 31 St, 2nd Fl, NY NY 10001)

Payroll Voucher CWA Local 1101

CWA District 1 PAF Card fillable (fill out and return to CWA Local 1101, 350 W 31 St, 2nd Fl, NY NY 10001)

Retirement Trust Application

Retirement Trust Instructions 

Steward Certification