To apply, please complete all applicable sections of this form and click "send." When we receive your application, we will call you to complete the process, which will require your signature. You may also call Toll Free 1-888-400-9303 -- In Baton Rouge, call 400-9303
** IMPORTANT: Form items marked in BLUE TEXT are required fields.
*** Not all State agencies are eligible for this program and the rates listed. Members of the LSU System, other State Universities, Community Colleges, Public School Systems, and the Louisiana Community and Technical
College System have their own payroll systems and are not included. Please contact Starmount or your Human Resources Representative with any questions.
ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON.