Full Name (First Last):
SSN:
Employer:
Monthly Wage:
Birthdate:
(mm/dd/yyyy)
Bargaining unit:
Employment status:
Job type:
Hire Date:
(mm/dd/yyyy)
Contact Phone:
(###) ###-####
Email (Optional):

(All information is required except your email)

If you are a new employee, we may not have received your hire information yet. You may enroll by filling out all required information on this page.

Please note that you selections will not be recorded until you have reached the final page and pressed the 'Submit Elections' button. At that time the system will display a receipt for you to print.

If you have any questions, please contact the Benefits Section at (800) 821-2251 (465-4460 in Juneau) or by email to doa.drb.benefits@alaska.gov



Version: REL_5_42_0