Exempt Benefits Enrollment Forms

Mandatory Forms 

Please fill out all 7 forms below and return them to Human Resources. If you have any questions with filling out the forms, please contact Helena Lang or Krystal Davis at human.resources@uleth.ca. If you have specific questions regarding your benefits, please contact Adriana Ota at adriana.ota@uleth.ca

1. These forms are to enroll into the Univeristy group benefits plan with Alberta Blue Cross -

PDF iconextended_health_and_dental_form.pdf

PDF iconalberta_blue_cross_direct_deposit_form.pdf


2. This form is to sign up for your mandatory basic life insurance through Great West Life. The rate sheet will be found in your welcome email. -

PDF iconbasic_life_insurance_form.pdf


3. These forms are to set up your payroll - 

PDF icondirect_deposit_form.pdf

PDF icontd1_alberta_form_2020.pdf

PDF icontd1_federal_form_2020.pdf


4. These forms are to enroll into the Public Service Pension Plan -


5. This form is only needed if you have a partner and/or you cannot find your marriage certificate.  

PDF icondomestic_partner_spousal_declaration_form.pdf


Optional Benefit Forms 

1. You have the option to purchase additional life insurance on top of the mandatory basic life insurance. For more information, please contact human.resources@uleth.ca.

2.  You have the option to purchase Accidental Death & Dismemberment Insurance. For more information, please contact human.resources@uleth.ca.



Your benefits at a glance

PDF iconemergency_contact_instructions.pdf

Exempt Support Staff Manual