HRS Forms

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 four categories: everything from Benefits to Performance Appraisals. Forms are in .pdf format unless otherwise noted.

• Benefits
• Payroll/Employee Records
• Recruiting, Hiring and Position Management
• Performance Appraisal
• Grievance and Mediation for Non-Represented Staff

• Quick Link to: US Department of Labor Forms

Benefits

Flexible Spending Accounts

• 2013 Flexible Spending Account Enrollment
• 2013 Campus Children's Center Flexible Spending Account Enrollment
• 2012 Flexible Spending Account Enrollment
• 2012 Campus Children's Center Flexible Spending Account Enrollment

• Direct Deposit - to set up direct deposit of your FSA reimbursement only
• Medical Flexible Spending Claim - to submit claims for medical expenses
• Dependent Care Flexible Spending Claim - to submit claims for dependent care expenses
• EBPA Reimbursement Portal (scan claim form and receipts, then upload)

Health Savings Accounts for Part-Time Faculty

• Health Savings Account (HSA) Enrollment Form   [HSA Info from the IRS]

Life Insurance

• Group Life Insurance
• Medical History Statement
• Change of Beneficiary

Long-Term Disability

• Long-Term Disability Enrollment

Medical and Dental Insurance

• BCBSVT Group Enrollment Form
• BCBSVT Hold Harmless Agreement
• BCBS Subscriber Claim
• BCBS Prescription Reimbursement
• Delta Dental Enrollment Application/Change Form
• Delta Dental Claim
• Same-Sex Health Care Stipend Enrollment/Termination
• Student Waiver for Dental Benefits
• Certification of Dependents
• Waiver of Medical Coverage

Retirees

• Change of Beneficiary

Retirement

• UVM's Retiree Health Savings Plan Election Form

• UVM's 403(b) Salary Reduction Form / Retirement Investment Agreement
• UVM's 457(b) Salary Reduction Form / Retirement Investment Agreement

• TIAA-CREF 403(b) Enrollment
• TIAA-CREF 457(b) Enrollment
• TIAA-CREF Rollover, Transfer or Exchange
• Fidelity 403(b) Enrollment
• Fidelity 457(b) Enrollment
• Prudential 403(b) Enrollment

• Enrollment Kit: TIAA-CREF 403(b) RA
• Enrollment Kit: TIAA-CREF 403(b) GSRA
• Enrollment Kit: TIAA-CREF 457(b)
• Enrollment Kit: Fidelity 403(b)

Tuition Remission

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

Payroll/Employee Records

• Additional Pay Form   See the mini-manual. Need an xls form?
• Additional Pay Form for UA-FT Faculty (U1 and U3)   See the mini-manual. Need an xls form?
• Direct Deposit Request (including a Notice of Federal Requirements)
• Direct Deposit Compliance Form - OFAC
• Distribution Form   (Excel, for new employees only.)
• Employee Information Form   (Fill out in Excel and print.)
• Employee Information Form   (Print and fill out.)
• FMLA Certification for Employee's Serious Health Condition
• FMLA Certification for Family Member's Serious Health Condition
• Form I-9   See the mini-manual.
• Form W-4
• Form W-4 VT
• Form W-11 Hiring Incentives to Restore Employment (HIRE) Act
• Leave of Absence
• Parental Leave Request - Faculty
• Personnel Actions Reference Guide
  • Personnel Action (PA) Change Form; see PA Change Instructions
  • Personnel Action (PA) Set-Up Form (Excel); see PA Set-Up Instructions
• Overtime Voucher
• Salary Payment Schedule (Faculty)
• Teacher's Oath
• Temporary Employee Payroll Form
• Termination Form
• United Academics Dues or Agency Fee Deduction Form

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)
• Sample Offer Letter (Word)

Grievance and Mediation for Non-Represented Staff

• Grievance and Mediation Policy - Staff (Non-Represented)
• Mediation Request Form
• Staff Grievance Information Form
• Grievant Reply Form