Forms
| A | B | C | D | E | F | H-I| J | L | M | N | O-P | R | S | U | V | W |
NOTES: Please use the following site to lookup the employee number; this number may be used in place of the social security number when completing forms found on this site. http://eelookup.admsrv.ohio.edu/eelookup/
Forms on this site are available in one of the following formats: Microsoft Word, Microsoft Excel and Adobe Acrobat.
You can receive a FREE version of Adobe Acrobat by visiting http://www.adobe.com/.
A- Forms
Address Change
Administrators, Performance Development Assessment
Adoption Benefit Financial Reimbursement Form
Anthem, Dental Claim
Anthem International Claim, BlueCard Worldwide®
Anthem Medical Claim
Anthem Student Certification
ARP Vendor Change
Award Request, Employee
UP
B- Forms
Beneficiary, Life Insurance
Benefits Enrollment (Microsoft Word)
Benefits, Dental Claim (Anthem)
Benefits, Evidence of Insurability
Benefits, Medical Claim (Anthem)
Benefits, Waiver of Group Health Insurance
BlueCard Worldwide®, Anthem International Claim
UP
C- Forms
Certification, Student
Change, Address
Classification Review
Classified Development Program (CDP) Application
Classified, Interim Base Wage Adjustment
Classified Non Bargaining, Probationary Evaluation
Comp Time
UP
D- Forms
Data Profile, Personnel
Dental Claim(Anthem)
Disability, OPERS (Print DR1 & DR3)
Disability, Reliance (Use if applying by June 30, 2011)
Disability, UNUM (use if applying after July 1, 2011)
DMA, Homeland Security
Domestic Partner, Affidavit
Domestic Partner, Enrollment
Domestic Partner, Statement of Termination
Domestic Partner, Tax Information
UP
E- Forms
Educational Benefit, Qualified Dependents 2010-2011 i.e. Spouse, Child, Domestic Partner (Word)
Educational Benefit, Qualified Dependents 2010-2011 i.e. Spouse, Child, Domestic Partner (pdf)
Educational Benefit, Qualified Dependents 2011-2012 i.e. Spouse, Child, Domestic Partner(Word) NEW!
Educational Benefit, Qualified Dependents 2011-2012 i.e. Spouse, Child, Domestic Partner(pdf) NEW!
Educational Benefit, Employee 2010-2011 (Word)
Educational Benefit, Employee 2010-2011 (pdf)
Educational Benefit, Employee 2011-2012 (Word) NEW!
Emergency Service Leave Request
Employee Award Request
Employee Recognition, (Appendix A)
Employment Interviewer Evaluation
Employment Verification, I-9
Exit Interview Questionnaire
Express Scripts Mail Order (Must register to complete form)
Express Scripts Reimbursement
UP
F- Forms
Family Medical Leave Act (FMLA) Forms Overview
Family Medical Leave Act (FMLA): Application for Family or Medical Leave (OU FMLA #.01)
Family Medical Leave Act(FMLA): Notice to Employees (OU FMLA #.02)
Family Medical Leave Act (FMLA): Eligibility Notice to Employer Under FMLA (OU FMLA #.03A)
Family Medical Leave Act (FMLA): Designation Notice Under FMLA(OU FMLA #.03B)
Family Medical Leave Act(FMLA): Certification of Physician/ Health Care Provider Employee) (OU FMLA #.04)
Family Medical Leave Act (FMLA): Medical Certification Statement
(Family Member or Caregiver Leave for Injured or Ill Service Member)(OU FMLA #.05)
Family Medical Leave Act (FMLA): Certification of Bonding Leave Due to Adoption or Foster Care (OU FMLA #.06)
Flexible Spending Account, Dependent Care, WageWorks
Flexible Spending Account, Healthcare, WageWorks
FTE Reduction, Voluntary
UP
H-I- Forms
Homeland Security, DMA
I-9 Employment Verification
Incident Report (Workers Compensation)
Interim Appointment Request NEW!
Interim Base Wage Adjustment (Classified)
International Claim, Anthem BlueCard Worldwide®
Interview, Employment Evaluation
Interviewer Evaluation
UP
J- Forms
Job Information Questionnaire (JIQ) - Classified
Job Information Questionnaire (JIQ)- IT
