Forms & Files

Adjuncts United
Add/Drop Dependents Benefits CoverageAUBenefitsForm.pdf
Benefits - Auto Insurance
MetLife Quote Request Formmetlifequote(2).pdf
Benefits - Dental
Delta Dentist’s Statement Formclaimform_ny.pdf
SEBF Dentist’s Statement Form SEBF.pdf
Benefits - Flexible Spending Accounts
Dependent Care Flexible Spending Account Formdcpaymeback.pdf
Health Care Flexible Spending Account Formhcpaymeback.pdf
Benefits - Life Insurance
MetLife Insurance Beneficiary FormMetLife Beneficiary Form.pdf
MetLife Insurance Statement of Health FormMetLifeHealthStatement.pdf
Benefits - Medical
POMCO Health Reimbursement Formpomco_reimburse.pdf
Schedule B Application - Fillable PDFSchedule-B-Application-Fillable-PDF
Benefits - Other
Adoption Assistance Plan FormHR105.doc
Child Care Subsidy Application - Fillable PDFChild-Care-Subsidy-Application-for-2017.pdf
Declaration of Marriage, Domestic Partnership, or Civil Union FormHR144.pdf
Dependent/Beneficiary FormHR115.doc
HIPAA Authorization Form for Employee, Spouse/Domestic Partner, and Dependentshippaafrm06.doc
Termination of Domestic Partnership FormHR109.doc
Termination of Domestic Partnership Form (pdf)HR109.pdf
Benefits - Prescriptions
Express Scripts (Medco) Reimbursement Form: Use only for Rx Filled Prior to December 31, 2015C1001.pdf
OptumRx Direct Member Reimbursement FormOptumRx_DMR_-form.pdf
OptumRx Home Delivery Order FormOptumRxHomeDeliveryOrderForm_2.pdf
Benefits - Short-Term Disability
Medical History Statement – The Standard Life Insurance Companysny13140_643921.pdf
Benefits - TIAA
Salary Reduction Form - 403(b) Voluntary Retirement Plantiaavols.pdf
Salary Reduction Form - Voluntary 457(b) Deferred Compensation Plantiaavols457.pdf
TIAA Enrollment Form - 403(b) Voluntary Retirement Plantiaaenrl.pdf
TIAA Enrollment Form - 457(b) Deferred Compensation Plan tiaaenroll457b.pdf
TIAA Enrollment Form - Noncontributory Retirement Plantiaaenrlnoncontrib.pdf
TIAA Waiver Letter and FormHR121.doc
TIAA Waiver Letter and Form (pdf)HR121.pdf
Benefits - Tuition
Dependent Tuition Benefit Application FormHR124.doc
Dependent Tuition Benefit Application Form (pdf)HR124.pdf
Remitted Tuition Credit Allocation AuthorizationHR123.doc
Remitted Tuition Credit Allocation Authorization (pdf)HR123.pdf
Tuition Exchange Request FormHR122.doc
Tuition Exchange Request Form (pdf)HR122.pdf
Benefits - Vision
VSP Reimbursement FormVSPreimbursement.pdf
FTE Calculatorcalc.xls
Pay Notification – ExemptWTPAExempt.doc
Pay Notification – FacultyWTPAFaculty.doc
Pay Notification – Non-ExemptWTPANonExempt.doc
Pay Notification – Non-Exempt SEIU Bargaining UnitWTPANonExemptSEIU.doc
Pay Notification – User Instruction MemoPay Notification - User Instruction Memo.pdf
Position & Search Administrative Approval RedirectPSAA Form Redirect.doc
Position Approval Memo (PAM) for FacultyPAMCOA.doc
Position Approval Memo (PAM) Form InstructionsPAMinstructions.pdf
Position Evaluation Request (PER)173_PER_Form_09.02.2016.docx
Position Evaluation Request (PER) Form InstructionsHR 173a Position Evaluation Request (PER) Form Instructions.pdf
Employee Relations
Staff Complaint Process Notification of ComplaintHR201.doc
Staff Complaint Process Notification of Complaint (pdf)HR201.pdf
Staff Complaint Process Request for AppealHR203.doc
Staff Complaint Process Request for Appeal (pdf)HR203.pdf
Faculty Voluntary Phased Retirement FormHR128.doc
Faculty Voluntary Phased Retirement Form (pdf)HR128.pdf
Job Offer Letter TemplateOffer-Letter-Template-Text.doc
Probationary Assessment FormHR302.doc
Reference Check FormHR305.pdf
Separation Checklistseparation-checklist.html
Faculty Parental Leave FormHR110.doc
Leave Request FormHR107.doc
Leave Request Form (pdf)HR107.pdf
Leaves - Disability
Application for Disability/Maternity BenefitsHR112.doc
Application for Disability/Maternity Benefits (pdf)HR112.pdf
Faculty Parental and Maternity Leave Checklist for Deans and Chairsparleavecklst.doc
Health Care Provider Information for Reasonable Accommodation Request Formhcprareq.doc
Health Care Provider Release Formhcprovid.doc
Return to Work – FacultyRTW-Fac.pdf
Return to Work – StaffRTW-Staff.pdf
Organizational Development
Flexible Work Arrangement Proposal and Approval Form411 FWA proposal agreement form.doc
Goals and Development Worksheetgoalsandd.docx
Performance Partnership (Supervisor Form)2017-Supervisor-Performance-Partnership-Form.docx
Payroll Allocation (PAR) Formdisplay.cfm_.html
Payroll Processing Calendarsdisplay.cfm2_.html
Request for Additional Pay (RAP) Formdisplay.cfm3_.html
Request for Reissue of Form W-2display.cfm4_.html
W-4 Formdisplay.cfm5_.html
Retiree Medical Election FormRetiree Medical Election Form.pdf
Retiree Opt In Medical FormRetiree Opt In Medical Form.pdf
Retiree Opt Out Medical FormRetiree Opt Out Medical Form.pdf
VSIP Subsidy Change FormVSIP Subsidy Change Form.pdf
SEIU Bargaining Unit – Affidavit of Opposite-Sex Domestic Partnership for Funeral Leave FormHR30309.doc
SEIU Bargaining Unit – Business Authorization/Time Record FormHR30301.doc
SEIU Bargaining Unit – Dues Deduction, Initiation Fee and Assessment Authorization FormHR30311.doc
SEIU Bargaining Unit – Job Appointment LetterSEIUJobAppt.docx
SEIU Bargaining Unit – Reference Check FormHR30307.doc
SEIU Bargaining Unit – Statement of Termination of Opposite-Sex Domestic Partnership FormHR30310.doc
Service Center
Alternative Job Transaction (AJT) FormHR130a.doc
Data Request Formdatareq.html
Demographic Action Notice (DAN)DAN.pdf
Demographic Action Notice, Unpaid Visiting Faculty/Research Associatesvfdan.doc
Name Change Form Name Change Form HR 139.doc
Personal Information Form (replaces Demographic Action Notice (DAN))PIF-HR 180 Revised 05-07-2015.pdf
Student Employment Services
Federal Work Study Reimbursement Request Formfws_reimbursement.doc
Off-Campus Employee Timesheetweekly_timesheet.doc
Student Employee Performance Reviewstudent_employee_performance_review.doc
Youth Programs
Youth Program QuestionnaireYouthProgramQuestionnaire.pdf