Farm Credit Foundations
Benefits Enrollment Form

Use this form to make your benefit elections.  You MUST complete the form in its entirety by either electing or waiving coverage.  This form must be completed and submitted within 45 days of your date of hire. 

Benefits will be effective the 1st or the 16th day of the month on or following enrollment.  If you do not enroll within 45 days of hire, you will automatically be enrolled in the employer-provided benefits (Basic Employee Term Life and Accidental Death and Dismemberment, Business Travel Accident, Long-Term Disability Insurance and the 401(k) program).  Once enrolled, your election is irrevocable unless a qualifying change of status occurs or you must wait until the next annual enrollment period to make changes.

See the New Hire section on www.FarmCreditFoundations.com for additional information.
EMPLOYEE INFORMATION
 
Name: 
First Name Required		 Last Name Required
      first   last
 
Employer: 
 Employer Required
 
Hire Date: 
 Hire Date is required.
 
Social Security Number: 
SSN Required
 
Work Email Address: 
Email Required