Forms & Supplemental Pay

General Forms

Municipal Fire and Police Supplemental Pay

Law Enforcement Recruitment Incentive Program

Act 367 Reg Session 2023

Application Packets

Scanned original and completely signed applications must be submitted on the SuMPay portal at sumpay.portal.la.gov. Keep the originals for your records. Partial or incomplete applications are not acceptable. All required documents must be submitted at the same time.

Police Application

Fire Application

Constable & Justice of the Peace Application

Supplemental Pay Rate and Pay Grid

Supplemental Pay Grid - Constables & Justices of Peace

Supplemental Pay Grid - Police, Fire, Marshal

Annual Certifying Signature Forms

Certificate of Prior Service

This form cannot be filled out by the employee. It must be executed by the prior service agency employed and included with the employee’s application that is submitted to our office.

Certificate of Prior Service

CJP Quarterly Reimbursement Request

Constable and Justice of the Peace Employer Share Quarterly Reimbursement Request

CJP Quarterly Reimbursement Request Form

Direct Deposit

Municipal Direct Deposit Form

Employee Address Change Form

If an employee needs to change his or her address, he or she should complete this form and fax it to 225-925-3973,e-mail it to [email protected], or mail it to P.O. Box 66614, Baton Rouge, LA 70896-6614. We do not need the original, but you should keep it for your records.

Employee Address Change Form

New Fire Dept. District Questionnaire

If you are employed by a newly established fire department or district, please have your hiring authority complete the form below and return the original by mail to P.O. Box 66614, Baton Rouge, LA 70896-6909.

New Fire Department-District Questionnaire

New Police Dept. District Questionnaire

If you are employed by a newly established police department or district, please have your hiring authority complete the form below and return the original by mail to P.O. Box 66614, Baton Rouge, LA 70896-6909.

New Police Department-District Questionnaire

Verification of Supplemental Pay

If a Supplemental Pay Recipient needs to show proof of receiving Supplemental Pay, he or she should have his financial institution submit the official banking form, with the recipient's release, to our e-mail address [email protected]. They should also send instructions with the correct e-mail address for our office to return the completed form back to the financial institution. Do not also mail originals!! Do not Fax.

If a Supplemental Pay Recipient needs to show proof of receiving Supplemental Pay for any reason other than financial (1.e., legal case, etc.), he or she should have his Municipality's administrative office complete the DPS form attached below, with the recipient's release, to our e-mail address [email protected]. They should also send instructions with the correct e-mail address for our office to return the completed form back to the Municipality. Do not also mail originals!! Do not Fax.

These procedures must be followed to ensure we do not violate privacy and identity issues. We will only discuss receipt of supplemental pay with those the Municipality has identified on the annual Certified Signature Authorization

Verification of Supplemental Pay

SuMPay Portal Login