NOTE: 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
Addendum to Administrative/Faculty Appointment for Unpaid Leaves
Address Change (Personal Data Change Notice)
Administrators, Performance Development Assessment
Adoption Benefit Financial Reimbursement Form
AFSCME Performance Evaluation
Anthem, Dental Claim
Anthem International Claim, BlueCard Worldwide®
Anthem Medical Claim
Anthem Student Certification
ARP Vendor Change
Award Request, Employee
UP
B- Forms
Bargaining Unit Performance Evaluation
Beneficiary, Life Insurance
Benefits Enrollment (Microsoft Word)
Benefits Enrollment (pdf)
Benefits, Dental Claim (Anthem)
Benefits, Evidence of Insurability Form
Benefits, Flexible Spending Account Reimbursement FlexPro
Benefits, Medical Claim (Anthem)
Benefits, Medical Claim
Benefits, Vision - (Faculty & Administrative Only)
Benefits, Waiver to Stop Automatic Rollover FlexPro
Benefits, Waiver of Group Health Insurance
BlueCard Worldwide®, Anthem International Claim
UP
C- Forms
Campus Directory, Update
Certification, Student
Change, Employee Personal Data
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 (Return to Human Resources)
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, Employee 2009-2010 (Word)
Educational Benefit, Employee 2009-2010 (pdf)
Educational Benefit, Qualified Dependents 2009-2010 i.e. Spouse, Child, Domestic Partner (Word)
Educational Benefit, Qualified Dependents 2009-2010 i.e. Spouse, Child, Domestic Partner (pdf)
EEO/AA Appraisal (Institutional Equity)
Emergency Service Leave Request
Employee Award Request
Employee Personal Data Change Notice
Employee Recognition, (Appendix A)
Employment Interviewer Evaluation
Employment Separation Checklist
Employment Verification, I-9
(Essential Position Request) Hiring Freeze Exemption Form UPDATED!
| Evidence of Insurability |
|
RETURN TO:
Fort Dearborn Life Insurance Company, Attn: Membership
1020 31st Street
Downers Grove, IL 60515
|
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
Fort Dearborn Life, Evidence of Insurability
FTE Reduction, Voluntary
UP
H-I- Forms
Hiring Freeze Exemption Form (formerly Essential Position Request)UPDATED!
Homeland Security, DMA
I-9 Employment Verification
Incident Report (Workers Compensation)
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
UP
L- Forms
Leave of Absence (Classified employees)
Leave of Absence/Work Related Injury
Leave,Organ Donation
Leaves, Unpaid- Addendum for Administrative/Faculty Appointments
Life InsuranceBeneficiary
UP
M- Forms
Mail Order, Express Scripts (Must register to complete form)
Medical Claim, Anthem
Mid-Year Base Wage Adjustment (Classified)
UP
N- Forms
UP
O, P- Forms
Organ Donation Leave, Request for
Paid Time Off: Faculty and Staff (Excel)NEW!
Paid Time Off: Faculty and Staff (pdf) NEW!
Performance Development Assessment, Administrators
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, Classified PM1*
