Get Jacobs Benefits Enrollment/change Form 2016-2025

This guide provides a comprehensive overview of how to complete the Jacobs Benefits Enrollment/Change Form online. By following these instructions, you can ensure that your benefits enrollment or changes are processed accurately and efficiently.

Follow the steps to complete your enrollment or change requests.

1. Press the ‘Get Form’ button to access the Benefits Enrollment/Change Form. This action will allow you to retrieve the form and fill it out in an online editor.
2. Identify the type of activity you are requesting changes for by checking all relevant reasons in Section I. This may include new hire, marriage, birth, or other qualifying life events.
3. In Section II, enter your personal information accurately. Include your last name, first name, middle initial, home address, phone numbers, hire date, and date of birth.
4. Proceed to Section III, where you will add dependent information if you wish to enroll them in benefits. Indicate their eligibility status and provide required details, such as names and social security numbers.
5. In Section IV, check the boxes for each benefit plan you wish to enroll in or make changes to. Ensure to review your choices for health benefits, dental plans, vision plans, and any disability benefits.
6. In Section V, be aware that certain voluntary plans require direct contact with the respective carriers for enrollment. Take note of the contact details provided for each plan.
7. Complete Section VI by authorizing payroll deductions. Review the information regarding the rollover of benefit elections and the consequences of misrepresentation before signing and dating the form.
8. Once all sections are filled out, save your changes, download a copy for your records, print the form if needed, or share it as required to ensure it is submitted to the JESI – HR Service Center.

Complete the Jacobs Benefits Enrollment/Change Form online today to secure your benefits.