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/.

24 Month Pay Option

403b & 457 Stop Order

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®
Anthem Social Security Number Exception
ARP Vendor Change
Award Request, Employee
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B- Forms
Beneficiary, Life Insurance
Benefits Enrollment, 2016-17 (Adobe) NEW!
  Submit with completed Life Insurance Beneficiary  form
Benefits Enrollment, 2016-17 (Word) NEW!
  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 Appeal
Classification Review
Classified Development Program (CDP) Application
Classified, Interim Base Wage Adjustment
Classified Non Bargaining, Probationary Evaluation
Comp Time
Complaint Alleging Workplace Violence
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D- Forms
Data Profile, Personal
Dental Claim (Anthem)
Direct Deposit
Disability, OPERS (Print DR1 & DR-APS; department to complete DR-2)
Disability, UNUM (use if applying after July 1, 2011)
Disability, Voluntary Self-Identification
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 2016- SUMMER 2017 (Word) NEW!
Educational Benefit, Qualified Dependents FALL 2016-SUMMER 2017 i.e. Spouse, Child, Domestic Partner (Word) NEW!
Educational Benefit, Request for Prior Year/SUMMER 2016 Email: uhr@ohio.edu  to request
Email Access 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

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
FTE Reduction, Voluntary
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G- Forms
Group III (New Temporary Admin or Adjunct Faculty Checklist)
Group III Transition Form, Position Description

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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
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

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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
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O, P- Forms
Occupational Injury, Sick Leave or Leave of Absence   
OIT Access, Request for
Organ Donation Leave, Request for
Paid Time Off: Faculty and Staff (Use Absence Management in MPI) NEW!
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)
Personal Data Profile
Pilot Parental Leave Form

Pilot Parental Leave Part-Time Form

Position Description Writing Instructions

Position Description UPDATED 2.3.16!
The Position Description replaces all other job documentation tools (JIQ, PCP, JQ)

Position Modification UPDATED!

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
Request for OIT Access
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
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 (Use Absence Management in MPI) NEW!
Social Security Number Exception, Anthem
State Service, Prior (Request for Transfer)
Student Employee Evaluation
Supervisor Feedback PM3
Supervisor Feedback PM3 (pdf)
Supplemental Retirement Account, 403b & 457 Stop Order
UP

T- Forms
Temporary Admin or Adjunct Faculty Checklist (Group III)
Twenty-four Month Pay Option

UP

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

V- Forms
Vacation: Faculty and Staff (Use Absence Management in MPI) NEW!
Vision Out of Network Reimbursement, VSP
Voluntary FTE Reduction
Voluntary Self-Identification of Disability

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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
Work Related Injury Reporting Packet NEW!
Workers Compensation, Incident Report
Workplace Alternative Arrangements Agreement Form
Workplace Violence, Complaint Alleging


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ACA
Benefits Spotlight: July 2016
The Journey~ Embracing Inclusion
PMG
Lynda.com
HERC