CWA LOCAL 1101 - Communications Workers of America  afl/cio
275 Seventh Ave.
New York, NY 10001
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Verizon Employee
FORMS
Just click on the pictures below to see 
the forms we have available.
We'll keep expanding this page for our Members!
Medical 
+
Disability
$
Union

Education

Globalfit Health Club Provider
Phone: 800-294-1500
 
PRINTABLE FORMS - PDF
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CWA 1101
UNION RELATED FORMS
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GRIEVANCE  FORM ( .PDF )


STATEMENT OF OCCURRENCE
(download time: apx 30 secs./229k)


SALARY  VOUCHER
(download time: apx 30 secs./277k)

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VERIZON
+MEDICAL RELATED


Family and Medical Leave Act (FMLA)
FMLA Medical Certification Form
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Empire BlueCross/BlueShield 
Verizon claim form


Davis Vision / The Eyecare Advantage web site
Plan Benefit Description
Davis Form



Dental Expense claim form

Disability
MET/LIFE forms 
Attending Physician Statement & Authorization to disclose information

Authoization to disclose medical information

MetLife's Behavioral Health Assessment Form
United Behavioral Health Claim Form

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VERIZON
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EDUCATION RELATED
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TUITION ASSISTANCE PROGRAM

TAP WEB SITE

Scholarship Applications

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Local 1101
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