HR Forms

Benefits and Payroll Forms

401(k) Enrollment Form (PDF)
401(k) Information (PDF)
401(k) Plan Highlights (PDF)
401(k) Loan Program (PDF)
401(k) Loan Application (PDF)
401(k) Plan Summary (PDF)
2010 Holidays (PDF)
2010 Pay Periods (PDF)
2009 W-4 Form (PDF)
ABC -LG Classic PPO 4 (PDF)
ABC -LG Lumenos HSA 2500 (PDF)
Direct Deposit Enrollment Form (MS word)
Flexible Benefits Summary Plan Description (PDF)
Guardian Coverage Brochure (PDF)
Request For Leave (MS Excel)
Timesheet - Standard - 2010 (MS Excel)

Employee Orientation Documents

Employee Evaluation Forms (RTF)
History of Health Services for American Indians (PDF)
History of Health Services for California Indians (PDF)
Karok – By William Bright (PDF)
Tribal Government Profile and Summary (PDF)

Enrollment Department Forms & Documents

Instructions for Obtaining Tribal ID Cards (PDF)
Karuk Questionnaire (expanded) (PDF)
Karuk Tribal Membership or Descendancy Application (PDF)
Back Page to MembershipApplication (PDF)

Education Department Forms & Documents

2010 Grant Award Application (PDF)
2010 Student Rent Voucher Application (PDF)

LIHEAP Department Forms & Documents

LIAP Application part1 (PDF)
LIAP Application part2 (PDF)

Miscellaneous Forms & Documents

Absentee Ballot Form (PDF)
Agenda Request Form (PDF)
Authorization to Submit Proposal (MS Excel)
Computer Access Request Form (MS Word)
Employment Application (PDF)
Employee Disciplinary Report (MS Excel)
Employee Evaluation Forms (MS Word)
IT Dept. Work Order (MS Word)
KTOC Resolution Template (MS Word)
KTOC Travel Advance Request (MS Excel)
Maintenance Work Request (PDF)
Mileage Request (MS Excel)
Office Supply Order Form (MS Word)
Personnel Action Notice (MS Excel)
Procurement Documentation Form (MS Excel)
Purchase Requisition (MS Excel)
Request for Contract (MS Excel)
Signature Verification Form (PDF)
State (CA) Auditor's Report (PDF)
Vehicle Incident Report (PDF)
Vehicle Usage Log (MS Excel)
Workers Comp Claim Form (PDF)

Air Ambulance Forms

If interested in applying for any of these supplemental air ambulance plans please contact Sara Spence at the Karuk Admin office in Happy Camp (530) 493-1600 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it (Downloads not recommended for users with dial-up connections due to large file size causing long download times.)

Reach for Life Application (PDF-1MB)
Mercy Air/PHI Application (PDF-new, small file)
Mercy Air/PHI App attachment (PDF-new, small file)
Mercy Flight Application (PDF-4MB)