Forms

Forms
| A | B | C | D | E | F | H-I | 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, Unpaid Leave of Absence
Administrators, Sick Leave
Administrators, Performance Development Assessment
Adoption Benefit Financial Reimbursement Form
Anthem, Dental Claim
Anthem International Claim, BlueCard Worldwide®
ARP Vendor Change
Award Request, Employee
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B- Forms
Beneficiary, Life Insurance
Benefits Enrollment (Microsoft Word) Submit with completed Life Insurance Beneficiary form
Benefits, Dental Claim (Anthem)
Benefits, Evidence of Insurability, Life Insurance
Benefits, Medical Claim (Anthem)
Benefits, Waiver of Group Health Insurance
BlueCard Worldwide®, Anthem International Claim
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C- Forms
Change, Address
Classification Review
Classified Development Program (CDP) Application
Classified, Interim Base Wage Adjustment
Classified Non Bargaining, Probationary Evaluation
COMP 2014 Classification Appeal NEW!
Comp Time
Complaint Alleging Workplace Violence NEW!
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D- Forms
Data Profile, Personal
Dental Claim (Anthem)
Disability, OPERS (Print DR1 & DR-APS; department to complete DR-2)
Disability, UNUM (use if applying after July 1, 2011)
Disability, Voluntary Self-Identification NEW!
Domestic Partner, Affidavit
Domestic Partner, Enrollment
Domestic Partner, Statement of Termination
Domestic Partner, Tax Information
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E- Forms
Educational Benefit, Employee FALL 2014- SUMMER 2015 (Word)  NEW!
Educational Benefit, Qualified Dependents FALL 2014-SUMMER 2015 i.e. Spouse, Child, Domestic Partner (Word) NEW!
Educational Benefit, Request for Prior Year Email: sinclaa1@ohio.edu to request
Emergency Service Leave Request

Employee Award Request

Employee Recognition Awards Guidelines
Employee Recognition, (Appendix A)
Employment Interviewer Evaluation
Employment Verification, I-9
Evidence of Insurability, Life Insurance
Exit Interview Questionnaire
Express Scripts Mail Order (Must register to complete form)
Express Scripts Reimbursement
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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
Flexible Work Schedule Agreement Form
Flexplace Agreement Form
FTE Reduction, Voluntary
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G- Forms
Group III (New Temporary Admin or Adjunct Faculty Checklist) NEW!

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H-I- Forms
Home Office Safety Guidelines and Agreement Form
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
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J- Forms

The Position Description replaces all other job documentation tools (JIQ, PCP, JQ)

L- Forms

Leave of Absence, Occupational Injury
Leave of Absence Request, Unpaid
Leave, Organ Donation

Life Insurance, Beneficiary

Parental Leave **NEW!
Parental Leave Partial Time Off/ Flex-Time **NEW!
Personal Data Profile

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M- Forms
Mail Order, Express Scripts (Must register to complete form) 
Medical Claim, Anthem
Mid-Year Base Wage Adjustment (Classified)
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N- Forms
New Temporary Admin or Adjunct Faculty Checklist NEW!
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O, P- Forms
Occupational Injury, Sick Leave or Leave of Absence
Organ Donation Leave, Request for

Paid Time Off: Faculty and Staff (Excel)

Paid Time Off: Faculty and Staff (pdf)
Parental Leave
Parental Leave Partial Time Off/ Flex-Time
Performance Development Assessment, Administrators
Performance Development Review (PDR)
Performance Development Review (PDR) Example
**The new Performance Development Review form should only be used by groups as they implement  the new compensation system and develop Position Competency Profiles (PCP's).
Performance Evaluation, AFSCME
Performance Management, Employee Activity Journal PM4
Performance Management, Employee Activity Journal PM4 (pdf)
Performance Management, Employee Self Evaluation PM5
Performance Management, Employee Self Evaluation PM5 (pdf)
Performance Management Review PM1 
Performance Appraisal for Classified Staff
Performance Management, Supervisor Feedback PM3
Performance Planning PM2
Performance Planning PM2 (pdf)

Pilot Parental Leave Form

Pilot Parental Leave Part-Time Form

Position Description Writing Instructions NEW!

Position Description NEW!
The Position Description replaces all other job documentation tools (JIQ, PCP, JQ)

Position Modification

Prior State Service (Request for Transfer)

Probationary Evaluation, Classified Non Bargaining

R- Forms
Recognition, Employee (Appendix A)
Reduction- in -Force Disclosure and Election 
Relocation Expense Repayment Agreement 
Request for Organ Donation Leave
Request for Reduction in Work Force
Resignation Form 
Retirement Separation
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S- Forms
Salary Reduction Agreement (from Payroll Site)
Sample Offer Letter Administrator
Search Firm Recruitment Report- Part A
Search Firm Recruitment Report- Part B
Separation Form NEW!
Sick Leave: AFSCME Bargaining Unit Employees (Excel)
Sick Leave: AFSCME Bargaining Unit Employees (pdf)
Sick Leave: Classified Employees (Excel) (NOT Required if using WorkForce system)
Sick Leave: Classified Employees (pdf) (NOT Required if using WorkForce system)
Sick Leave Conversion
Sick Leave: Faculty and Staff (Excel)
Sick Leave: Faculty and Staff (pdf)

Sick Leave, Request to Donate NEW!

Sick Leave, Request to Receive Donated Sick Leave NEW!

State Service, Prior (Request for Transfer)

Student Employee Evaluation
Supervisor Feedback PM3
Supervisor Feedback PM3 (pdf)
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T- Forms
Temporary Admin or Adjunct Faculty Checklist (Group III) NEW!

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U- Forms
Unacceptable Behavior Incident Report
Unpaid Leave of Absence Request

V- Forms
Vacation: Faculty and Staff (Paid Time Off) Excel
Vacation: Faculty and Staff (Paid Time Off) pdf
Vision Out of Network Reimbursement, VSP
Voluntary FTE Reduction
Voluntary Self-Identification of Disability NEW!

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W- Forms
W- 4 Tax Form
WageWorks, Flexible Spending Account- Dependent Care
WageWorks, Flexible Spending Account- Healthcare
Waiver of Group Health Insurance, Benefit
Workers Compensation, Incident Report
Workplace Violence, Complaint Alleging NEW!

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ACA
Comp2014
The Journey~ Embracing Inclusion
PMG
Lynda.com