HR Forms
See also Important Links for Forms at Third-Party Websites
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| Applicaton |
APPLICATION FOR EMPLOYMENT IN PDF FORMAT (PDF, 247 K)
Requires Adobe Reader, free at www.adobe.com.
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APPLICATION FOR EMPLOYMENT IN RTF FORMAT (RTF, 152 K)
For viewing with generic word processing software.
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APPLICATION FOR EMPLOYMENT IN WORD FORMAT (MS Word, 80 K)
Requires Microsoft Word.
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| Benefits |
403B REDUCTION FORM (PDF, 21 K)
Voluntary Tax Sheltered Annuity 403(b) Enrollment and Change Form.
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PERS BENEFICIARY DESIGNATION FORM (PDF, 166 K)
Update Public Employees Retirement System beneficiary information.
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PERS CHANGE PERSONAL INFORMATION (PDF, 389 K)
Change personal information with Public Employees Retirement System.
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STANDARD INSURANCE COMPANY CHANGE FORM (PDF, 73 K)
Beneficiary designation and change form
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| Claims |
DENTAL CLAIM FORM (PDF, 23 K)
For dental claim reimbursement.
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MEDICAL CLAIM FORM (PDF, 20 K)
For state self-funded medical and vision plan claims reimbursement.
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PRESCRIPTION CLAIM FORM (PDF, 42 K)
Prescription claim form from Catalyst Rx
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| Hiring/Compensation |
FICA - NEW HIRE (MS Word, 34 K)
Used by departments for hiring new part-time Classified and Letter of Appointment Employees New = hired after 7/1/05 or has not been paid for one year.
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I-9 (PDF, 184 K)
Required for all New Hires. Must be completed and returned to H.R. before employee beings working.
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OATH (MS Word, 33 K)
Required for all Academic Faculty.
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PERSONAL DATA FORM (PDF, 462 K)
Completed by all employees at new hire and some demographic data changes.
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SSA-1945 (MS Word, 30 K)
Explanation and Statement concerning Employment in a job that is not covered by Social Security. Used for Classified and Faculty Employees.
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VARIABLE WORKDAY SCHEDULE (MS Word, 258 K)
Classified employees only.
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| Payment Form |
| INDEPENDENT CONTRACTOR AGREEMENT |
| Payroll |
BENEFICIARY FOR UNPAID COMPENSATION (PDF, 34 K)
This form designates a beneficiary for your last paycheck.
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DIRECT DEPOSIT - FLAT AMOUNT - STOP (MS Word, 24 K)
Stop a flat amount that is being deducted from your pay check.
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DIRECT DEPOSIT - FLAT AMOUNT (MS Word, 26 K)
To select a flat amount to be taken out of your check and distributed to a different account.
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DIRECT DEPOSIT - STOP (MS Word, 24 K)
Stop your current direct deposit.
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DIRECT DEPOSIT (MS Word, 25 K)
Faculty/Classified/Student/Hourly employees - Please include a voided check with this request. Deliver to Human Resources.
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HOURLY TIMESHEET (MS Excel, 32 K)
Used by Part-time Classified employees and student workers.
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PAY REQUEST (MS Excel, 25 K)
Used for Part-time Instructors, LOA and Overload payments. (DEPARTMENTAL USE ONLY)
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TIME SHEET SCHEDULE (MS Excel, 18 K)
Dates that timesheets are due to the Human Resources office.
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W-4 (PDF, 242 K)
IRS Federal Tax withholding form.
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| Workers' Compensation |
C-1 (PDF, 585 K)
Completed by employee when an injury or occupational disease occurs. Must be submitted within 7 days of the incident.
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VOLUNTEER AGREEMENT (PDF, 17 K)
Used when a volunteer Category "B" volunteer is engaged: A category "B" volunteer is a person who performs a volunteer assignment for more than three days or on a recurring basis.
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