Forms
Benefits
- Blue Cross Active Employees Group Enrollment Form
- Blue Cross Retirees Group Enrollment Form
- Domestic Partner Declaration Form
- Designation of Beneficiary, Basic and Supplemental Life Insurance
- Designation of Beneficiary Form for Minors, UTMA
- Fee Reduction Authorization Form
- FMLA Physician Statement Form(for Employee)
- FMLA Physician Statement Form (for Family Member)
- FMLA Leave Request Form
- Flexible Spending Account Reimbursement Form
- Shared Leave, Transfer to Bank Form
- Shared Leave, Transfer of Vacation Hours (EIS-180)
- Vision Services Plan Out-of-Network Reimbursement Form
Employment
- Address Change Form
- Affirmative Action 1-75 - Position Announcement
- Affirmative Action 1a-75 - Selection Criteria
- Affirmative Action 2-75 - Applicant Identification
- Affirmative Action 3-75 - Position Vacancy Record/Report
- Emergency Contact Form
- Exiting Employee Checklist
- Exiting Employee Survey
- I-9 Form
- Limited Service Agreement
- New Hire Packet, Temp/Student Employees
- Performance Evaluation Form - Non-Classified Employee
- Performance Evaluation Form - Classified Employee
- Position Description Questionnaire (PDQ) for Classified Employees
- Salary Adjustment Request
- Temporary
Change In Payroll Account Distribution
- Voluntary Probation Agreement Form
- Volunteer Policy
- Volunteer
Services Agreement
- W-4 Form
Retirement
- 403(b) Salary Reduction Agreement Form
- 457(b) Salary Reduction Agreement Form
- PERSI Additional Payment Agreement Form
- PERSI Beneficiary Designation Form
- PERSI Certification of Employment of a Retired Member Form
- PERSI Choice Plan 401(k) Enrollment Form
- PERSI Member Address Change Form
- PERSI Membership Application Form
- PERSI Notice of Separation or Leave of Absence/Return from Leave of Absence Form
- PERSI Separation Benefit Payment Request Form
- Separation Benefit Payment Request Instructions
- Important Separation Benefit Payment Request Information
- TIAA-CREF On-Line Enrollment Form, ORP, 403(b), and 457(b) plans
Version 1/26/2006