Forms

Forms
| A | B | C | D | E | F | H-I | L | M | N | O-P | R | S | T | 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. https://webapps.ohio.edu/eelookup/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/.

12 Month Pay Option (Faculty)

403b & 457 Stop Order

A- Forms
Address Change (MPI: Personal Information)
Administrators, Unpaid Leave of Absence
Administrators, Sick Leave  (MPI: Absence Management)
Administrators, Performance Development Assessment
Adoption Benefit Financial Reimbursement Form
Allowance Request (for cell phones and other items)
Anthem, Dental Claim
Anthem International Claim, BlueCard Worldwide®
Anthem Social Security Number Exception
Appointment Form (for faculty and administrative appointments)
ARP Vendor Change
Award Request, Employee
UP

B- Forms
Beneficiary, Life Insurance
Benefits Enrollment
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
UP

C- Forms
Change, Address (MPI: Personal Information)
Classification Appeal
Classification Review
Classified Development Program (CDP) Application
Classified Non Bargaining, Probationary Evaluation
Comp Time
Complaint Alleging Workplace Violence
UP

D- Forms
Data Profile, Personal
Dental Claim (Anthem)
Dependent Care Flexible Spending Account, WageWorks
Direct Deposit
Disability, OPERS (Print DR1 & DR-APS; department to complete DR-2)
Disability, UNUM Long Term
Disability, UNUM Short Term
Disability, Voluntary Self-Identifcation (MPI: Disclose Disability Status)
Domestic Partner, Affidavit
Domestic Partner, Enrollment
Domestic Partner, Statement of Termination
Domestic Partner, Tax Information
UP

E- Forms
Educational Benefit, Employee FALL 2017- SUMMER 2018 (Word) NEW!
Educational Benefit, Qualified Dependents FALL 2017-SUMMER 2018 i.e. Spouse, Child, Domestic Partner (Word) NEW!
Educational Benefit, Request for Prior Year/SUMMER 2017 Email: uhr@ohio.edu  to request
Email Access Request
Emergency Service Leave Request

Employee Award Request
Employee Recognition Awards Guidelines
Employee Recognition, (Appendix A)
Enrolling in Benefits
Evidence of Insurability, Life Insurance
Existing Student Employee Information Sheet
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
Flexible Work Schedule Agreement Form
Flexplace Agreement Form
Fraud, State
FTE Calculator
FTE Reduction, Voluntary
UP

G- Forms
Group III (New Temporary Admin or Adjunct Faculty Checklist)
UP

H-I- Forms
Healthcare Flexible Spending Account, WageWorks
Home Office Safety Guidelines and Agreement Form
Incident Report (Workers Compensation)
International Claim, Anthem BlueCard Worldwide®
Interviewer Evaluation
IT-4NR Reciprocity Tax (to be completed by residents of Indiana, Kentucky, West Virginia, Michigan or Pennsylvania)

UP

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

Long Term Disability UNUM
UP

M- Forms
Mail Order, Express Scripts (Must register to complete form) 
Medical Claim, Anthem
UP

N- Forms
New Employee Tax Compliance Notification
New Hire Notification STRS
New Student Employee Pre-Hire Form
New Temporary Admin or Adjunct Faculty Checklist
UP

O, P- Forms
Occupational Injury, Sick Leave or Leave of Absence   
OIT Access, Request for
OPERS Exemption Form  (Learn more here)
OPERS Employee Information Sheet
Organ Donation Leave, Request for
Paid Time Off: Faculty & Staff (MPI: Absence Management)
Parental Leave
Parental Leave Partial Time Off/ Flex-Time
Part-time/ Overload Appoint Form

   Click here for the Overload Request Form  and additional information regarding overlaods.
Payroll Expense Accounting Correction (PEDS)
Payroll Summary Sheet
Performance Evaluation, AFSCME
Performance Appraisal for Classified Staff
Performance Evaluation Form 

Personal Data Profile
Position Description Writing Instructions
Position Description
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

Q- Forms

Qualifying Benefits Life Event NEW!

R- Forms
Reciprocity Agreement (to be completed by residents of Indiana, Kentucky, West Virginia, Michigan or Pennsylvania)
Recognition, Employee (Appendix A)
Record of Taxable Uniform
Reduction- in -Force Disclosure and Election 

Relocation Expense Repayment Agreement 
Request for Organ Donation Leave
Request for Reduction in Work Force
Request for OIT Access
Resignation Form 
Retirement Separation
UP

S- Forms
Salary Reduction Agreement
Separation Form
Short Term Disability UNUM 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 & Staff (MPI: Absence Management)
Social Security Number Exception, Anthem
SSA-1945 for OPERS
SSA-1945 for STRS
State Fraud Form
State Service, Prior (Request for Transfer)
STRS, New Hire Notification
Student Employee Evaluation
Student, Existing Employee Information Sheet
Student, New Employee Pre-Hire Form
Supervisor Feedback PM3
Supervisor Feedback PM3 (pdf)
Supplemental Retirement Account, 403b & 457 Stop Order
UP

T-Forms
Tax Forms (VP for Finance Site)
Time Sheet- Classified
Time Sheet- Student
Temporary Admin or Adjunct Faculty Checklist (Group III)
Twelve Month Pay Option
UP

U- Forms
Unpaid Leave of Absence Request
UP

V- Forms
Vacation, Faculty & Staff (MPI: Absence Management)
Veteran Status (MPI: Disclose Veteran Status)
Vision Out of Network Reimbursement, VSP
Voluntary FTE Reduction
Voluntary Self-Identifcation of Disability  (MPI: Disclose Disability Status)

UP

W- Forms
W4 Withholding Exemption Forms, Federal and State (Kentucky Residents)
W4 Withholding Exemption Forms, Federal and State (Ohio Residents)
W4 Withholding Exemption Forms, Federal and State (West Virginia Residents)
WageWorks, Flexible Spending Account- Dependent Care
WageWorks, Flexible Spending Account- Healthcare
Work Related Injury Reporting Packet NEW!
Workers Compensation, Incident Report
Workplace Alternative Arrangements Agreement Form
Workplace Violence, Complaint Alleging

UP

ACA
PMG
The Journey~ Embracing Inclusion
Lynda.com
HERC