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Human Resources Census Form

The maximum number of form submissions has been reached. This form is currently not available.
- Please submit one form per employee who is working 30 or more hours per week, regardless of whether they are enrolled currently in any of our group insurance programs,
  If you have NO employees who qualify, simply answer the first question and your parish info and submit.
  Thank you.
- Do you have any employees who work 30 or more hours per week? REQUIRED Please fill out this field.
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Zip Code of their residence Maximum 5 characters
  5 digit only
  Please enter valid data.
- Date of birth
  MO-DA-YEAR
  Please enter a date.
- Gender
- Number of Family Members in the household Maximum 13 characters
  enter a number
  Please enter an integer (number) from 0 to 13.
- Name of Parish, School or Agency REQUIRED Please fill out this field. Please enter valid data.
- City or Town in which your main office is located REQUIRED Please fill out this field. Please enter valid data.
Submit

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