Employee Forms

Change of Address Form - use this form for name and/or address changes

Fiscal Forms


Direct Deposit - please include a copy of your VOIDED check in order to sign up for Direct Deposit

W-4 - 2017

Emergency Payroll Advance Request

Payroll Change Form

Accounts Payable

Accounts Payable Direct Deposit - for employee mileage reimbursements, travel or any other non-payroll payments

W-9 Form


New Employee Member Enrollment Form

Appeal Form - You may appeal to OEBB about dependent eligibility decisions, enrollment errors and omissions, Healthy Futures, or missed enrollment timelines.

Opt Out Form - In accordance with the participation requirements for OEBB opt-out provisions, OAR 111-040-0050 and the District's association agreements, members who elect not to participate in the OEBB Health Plan including medical, pharmacy, dental and vision coverage wil be entitled to receive a monthly financial incentive.

Mid-Year Change Form

Beneficiary Form

Health and Safety Forms


SAIF/801 Form - fillable - form must be opened in Adobe to enable fillable feature

Short Term Disability (STD)

American Fidelity

Standard STD


Request for unpaid absence


OFLA/FMLA request form

Health Care Provider Certification

Fitness for Duty Questionnaire



Douglas Education Service District | 1871 NE Stephens | Roseburg, OR 97470
Telephone: 541.440.4777 | Fax: 541.440.4771

Admin Login

Accessibility Statement - The Douglas ESD is committed to making its electronic and information technologies accessible to individuals with disabilities by meeting or exceeding the World Wide Web Consortium’s (W3C’s) Web Content Accessibility Guidelines (WCAG) 2.0 Level AA and the Web Accessibility Initiative Accessible Rich Internet Applications Suite (WAI-ARIA) 1.0 for web content. We are currently in the process of upgrading our site to meet all requirements.

For more information on how to report an issue related to the accessibility or how to file a formal Section 504 or ADA (Title II) complaint about the accessibility of any content on our website, please see our full Accessibility Statement.

Anti-Discrimination Policy - It is a policy of the Douglas ESD that there will be no discrimination or harassment on the grounds of race, color, sex, marital status, religion, national origin, age, sexual orientation, or disability in any educational programs, activities or employment. For more information, visit the Nondiscrimination Policy page.