Often working with Human Resource Services involves filling out forms--enrolling, changing, requesting, stopping . . . there are forms for most of the things that employees need to do. They're all listed here under one of five categories: everything from Benefits to Performance Appraisals.

Benefits

Medical & Dental Insurance

• BCBS Enrollment/Change (pdf)
• BCBS Hold Harmless Agreement (pdf)
• BCBS Subscriber Claim (pdf)
• BCBS Student Waiver (pdf)
• BCBS Prescription Reimbursement (pdf)
• MVP Enrollment/Change (pdf)
• MVP Student Waiver (pdf)
• Delta Dental Enrollment/Change (pdf)
• Delta Dental Claim (pdf)
• Student Waiver for Dental Benefits (pdf)
• Certification of Dependents (pdf)
• Waiver of Medical Coverage (pdf)

Flexible Spending Accounts

• EBPA Document Submission Portal (scan claim form + receipts and upload)
• 2010 Flexible Spending Account Enrollment (pdf)
• 2010 Campus Children's Center Flexible Spending Account Enrollment (pdf)
• 2009 Flexible Spending Account Enrollment (pdf)
• 2009 Campus Children's Center Flexible Spending Account Enrollment (pdf)
• Direct Deposit (pdf) - for direct deposit of your FSA reimbursement only
• Health Flexible Spending Claim (pdf) - to submit claims for medical expenses
• Dependent Care Flexible Spending Claim (pdf) - to submit claims for dependent care expenses

Life Insurance

• Group Life Insurance (pdf)
• Medical History Statement (pdf)
• Change of Beneficiary (pdf)

Long-Term Disability

• Long-Term Disability Enrollment (pdf)

Retirees

• Change of Beneficiary (pdf)

Retirement

• Salary Reduction/Investment Agreement for 403(b) (pdf)
• Fidelity 403(b) Enrollment (pdf)
• TIAA/CREF 403(b) Enrollment (pdf)
• Prudential 403(b) Enrollment (pdf)
• Retirement Salary Deferral 457(b) (pdf)
• Fidelity 457(b) Enrollment (pdf)
• TIAA/CREF 457(b) Enrollment (pdf)

Tuition Remission

• Tuition Remission Request (pdf)
• Tuition Remission Application for Part-time Represented Faculty (pdf)
• Procedures for Off-Campus Tuition Reimbursement (for employees who live and work over 40 miles from campus)

Payroll/Employee Records

• Additional Pay Form (former "EPV") (Excel)
• Additional Pay Form for UA-Represented FT Faculty (U1 and U3) (Excel)
• Direct Deposit Request (pdf)
• Distribution Form (Excel, for new employees only)
• Employee Information Form (pdf)
• FMLA Certification) (pdf)
• Form I-9 (pdf)
• Form W-4 (pdf)
• Form W-4 VT (pdf)
• Leave of Absence (pdf)
• Personnel Actions Guide
  • Personnel Action (PA) Change Form (pdf)
  • Personnel Action (PA) Set-up Form (Excel); see instructions (pdf)
• Overtime Voucher (pdf)
• Salary Payment Schedule (Faculty) (pdf)
• Teacher's Oath (pdf)
• Temporary Employee Payroll Form (pdf)
• Termination Form
• United Academics Dues or Agency Fee Deduction Form (pdf)

Staff Performance Appraisal

• Employee Performance Appraisal (Word)
• Supervisor Performance Appraisal (Word)
• Self-Assessment Form (Word)

Recruiting, Hiring, and Position Management

• New Employee Orientation Registration
• Position Description for Staff (Word)
• Reference Check for Job Applicants (Word)

Faculty Appointment Letter Templates

• Faculty Appointment Letter Templates

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