Human Resources Forms
Onboarding Forms
- Acknowledgement of Rights and Responsibilities(Workers’ Comp)
- Adjunct Faculty Application
- Background Check Disclosure
- Background Clearance Certification For Provisional Employment
- C-Form
- Direct Deposit Form
- Drug Free Workplace
- Emergency Contact Form
- Employee Handbook Confirmation
- English Fluency Form
- I-9 Form
- I-9 Form Instructions
- IRS W-4 Form
- New Hire Checklist Part-Time Faculty
- Post Employment Data Form
General HR Forms
- Business Card Order Form
- C-Form
- Change of Employee Information Form
- Classified Position Bid Form
- Exit Form
- Request for Temporary Agency Worker Form
- For Chosen Name, ADA Accomodations, and
Veteran or Disability Self-Identification Forms,
visit the Diversity & Equity Forms site.
Benefit Forms
- Benefit Enrollment/Change Form
- COBRA Rights
- COBRA Rates (pdf)
- Health Benefits Waiver
- Life Insurance Beneficiary Form
- Long-term Disabilities Acknowledgement Form
- PSERS/SERS Pension Plan Attestation Form
- Retirement Plan Contribution Form
- Student Verification Form for Dental Insurance
- Tuition Remission and Course Registration Application
- Income Protection Benefit (IPB) Authorization Form
- IBC- International Claim Form
- IBC- PPO Out of Network Claim Form
- Keystone- POS Out of Network Claim Form
Adjunct/VL Benefit Forms
- ACH Direct Payment Plan Authorization Form
- Adjunct Faculty Benefit Enrollment Form
- Delta Dental Enrollment Form
- Health Benefits Waiver (VL)
- PSERS/SERS Retirement Plan Attestation Form
- Participation Rules Release Form
- Reimbursement for Coverage Elsewhere (Adjunct/VL)
- Retirement Plan Contribution Form
- United Concordia Enrollment Form
Medical Leave of Absence and Medical Leave (FMLA) Forms
- Authorization for Release of Medical Information
- Attending Physician's Statement of Medical Condition
- Certification of Health Care Provider for Employee
- Certification of Health Care Provider for Family Member
- Employee’s Request for Family & Medical Leave
- Employee Rights and Responsibilities under the Family and Medical Leave Act
- HIPAA Notice of Privacy Practices
- Release to Return to Work - Fitness to Duty
Evaluation/Information Forms
- Administrative Staff Performance Rating Guide - Admins
- Annual Performance Appraisal Form – Admins
- Annual Performance Appraisal Form - Classified/Confidential
- Probationary Evaluation Form - 30 Day - Classified Staff
- Probationary Evaluation Form - 90 Day - Confidential Staff
- Probationary Evaluation Form - 90 Day - Classified Staff
- Probationary Evaluation Form - 90 Day - Administrative/New Hires