Forms
If you are not able to find a form by filtering please email hrweb@ohio.edu.
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Faculty can complete this form to have their salary spread over the whole year. Otherwise faculty are paid semi-monthly August 31 through May 15. Available at the start of Fall Semester. |
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Please report any access issues or barriers, or request an alternative format. |
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Access MPI: Personal Information to change your home address. This will update your address with Payroll as well as Benefits vendors. You will need to notify your retirement carrier separately. |
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Use this form to request reimbursement for adoption expenses. |
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This form is used to evaluate the performance of classified bargaining unit employees. |
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Form used when covered member is unable or unwilling to comply with request to provide SSN. |
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This form is completed by the department for all faculty and administrative appointment changes generally outside of reappointment to base salary, fiscal increments, additional salary and additional pay. |
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This form is used to change alternative retirement plan providers. |
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Form to request gift, gift certificate, or Bobcat Cash for an employee. |
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You may enroll in or make changes to benefits by accessing the Self Service Benefits module of My Personal Information. |
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Used to appeal a classification. |
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This form can be submitted by your dentist for a pre-treatment estimate or a claim for actual services. |
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Use this form to start or change Direct Deposit. |
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Link to forms required to apply for long term disability with OPERS. |
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Call STRS at 1-888-227-7877 to request forms required to apply for long term disability. |
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Use this form to submit claims for UNUM Long Term Disability: employee statement, authorizations, attending physician statement, etc. |
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Instructions for submitting a Short Term Disability claim. |
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Access MPI: Personal Information to voluntarily disclose a disability. |
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Complete to establish domestic partnership to cover as a dependent for medical and/or educational benefits as well as sick leave. |
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Complete if covering a domestic partner and/or dependents for medical coverage. |
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Complete within 30 days of the termination of a domestic partnership. |
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Completed by regional campuses when requesting the rehire of a retiree. |
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Employees should complete this form each semester enrolled in classes to apply for the tuition waiver. Must secure supervisor and department head signatures. |
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To be completed by the employee each academic year to apply for the tuition waiver for qualified dependents. |
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Request for Access to IT Resources- required to formally request any type of departmental access to another user's OHIO accounts or systems |
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Employees are eligible for 40 hours of emergency service leave in a calendar year. This includes volunteer firefighters, paramedics, EMT and First Responders. |
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Employee award request form for a gift, gift certificate, or Bobcat Cash |
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Employee recognition award guidelines. |
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Employee recognition policy Appendix A. |
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Complete if requesting supplemental life insurance in amount above guaranteed issue. Submit directly to Securian Life. |
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Student employee information |
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Exit Interview general information questionnaire |
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Register online to complete form to receive home delivery of mail order prescription(s). |
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Complete this form to be reimbursed for a prescription drug that you paid out of pocket. |
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FMLA: Application for Family or Medical Leave (OU FMLA #.01) [Excel] |
Employee completes and submits to department when requesting Family Medical Leave. |
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FMLA: Certifiaction of Bonding Leave Due to Adoption or Foster Care (OU FMLA #.06) [PDF] |
From to request leave due to adoption or foster care. Employee completes top portion of form, professional provider completes bottom portion. Form to be submitted to department. |
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FMLA: Certification of Physician/ Health Care Provider Employee (OU FMLA #.04) [PDF] |
Health Care Provider Certification for employee’s own serious illness: Employee provides form to the Physician or Health Care Provider to be completed by the Physician or Health Care Provider for the employee's own serious illness. Form to be submitted to department within 15 days of request. |
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Department or supervisor completes and provides to employee within five business days of obtaining information to determine whether the requested leave is Family Medical Leave-qualifying, as specified in form OU FMLA#.03A. This form is the designation notification to the employee under the Family Medical Leave Act. |
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FMLA: Eligibility Notice to Employer Under FMLA (OU FMLA #.03A) [Excel] |
Department or supervisor completes and provides to employee within five business days of request or knowledge of leave need. This form is the eligibility notification to the employee under the Family Medical Leave Act. |
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Forms and Guidelines information for FMLA. |
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Health Care Provider Certification for serious illness of family member: Employee provides form to the Physician or Health Care Provider to be completed for the illness of a family member or if taking caregiver leave for an injured or ill Covered Service Member. Form to be submitted to department within 15 days of request. |
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Department or supervisor to provide this informational form to the employee or should direct employee to location of form when employee is requesting Family Medical Leave. |
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Complete this form to request reimbursement from your WageWorks Dependent Care Account. |
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Complete this form to request reimbursement from your WageWorks Healthcare Account. |
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Used when administrators request a change to their regularly scheduled work hours arrangement. |
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Used when administrators request a flexplace arrangement |
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Acknowledgement of receipt of Auditor of State fraud reporting system information. |
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Academic FTE chart for overload and summer appointments. |
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Voluntary short-term FTE Reduction Agreement for administrative staff. |
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Home office safety guidelines and agreement form. |
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To be completed by supervisor and employee immediately after a work-related injury, illness or incident. |
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Form used to submit institutional and professional claims for benefits for covered services received outside the US, Puerto Rico and the US Virgin Islands. |
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This form is a guide for interviewers to allow them to objectively evaluate the candidate’s suitability for employment. |
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Employee Statement of Residency in reciprocity state (Indiana, Kentucky, West Virginia, Michigan or Pennsylvania). |
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Complete to designate your life insurance beneficiary. |
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| Life Insurance Conversion | Call Minnesota Life at 1-866-365-2374 to receive information on converting life insurance if you separate employment. |
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Use to submit a medical claim form to Anthem. |
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New employees who are not citizens or permanent resident aliens of the United States are required to complete this form. |
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| New Hire Checklist for Departments [Excel] | Departments/Supervisors are encouraged to utilize this checklist for new employees. |
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To be completed by new faculty withing ten days of start date. |
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Supervisors should provide this form to new student employee at the time of hire. |
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This form should be submitted within 24 hours of the injury/ incident of a non employee. |
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Occupational Injury/Illness, option of sick leave or unpaid medical leave of absence. |
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OPERS Employee Information Sheet- replaces current Personal History Record for OPERS Members |
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OPERS optional exemption as a student |
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This form should be completed if requesting leave for the purpose of organ donation. |
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Faculty and administrations should access the MPI: Absence Management link to request paid time off. |
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May be completed by employee with tentative dates with revised form submitted after birth/adoption. Appropriate sick or vacation forms should be attached if applicable. |
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Complete if requesting partial time off or flex time parental leave. |
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Payroll Expense Accounting Correction form. |
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Performance evaluation including personal goals and self-assessment. |
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Complete form to provide educational history and licenses and certifications required for position. |
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| Position Description [PDF] | A summary of the most important features of a job, including the general nature of the work performed (essential duties and responsibilities) and level (e.g., skills, effort, responsibility and working conditions) of the work performed. It typically includes job specifications that detail employee characteristics required for competent performance of the job. A job description describes and focuses on the job itself, not on any specific individual who might fill the job. |
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A summary of the most important features of a job, including the general nature of the work performed (essential duties and responsibilities) and level (e.g., skills, effort, responsibility and working conditions) of the work performed. It typically includes job specifications that detail employee characteristics required for competent performance of the job. A job description describes and focuses on the job itself, not on any specific individual who might fill the job. |
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This form is used to request a change to the details of a position, such as title, organization name, employment category, months worked, FTE, or supervisor change. This form can also be used to abolish a vacant position that will not be used in the future. |
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Submit to previous employee to request transfer of prior state service credit and sick leave. |
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Used to evaluate performance of classified non bargaining unit employees during their probationary period. |
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If you experience a qualified benefits life event call the Employee Service Center (740) 593-1636 to initiate a life event. You may then access the Self Service Benefits module of My Personal Information to make changes. |
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To be completed by residents of Indiana, Kentucky, West Virginia, Michigan or Pennsylvania for tax purposes. |
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CFAO or their delegate should forward a copy of this form to the employment tax accountant, payrolltax@ohio.edu. |
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Form for administrative employees and classified staff who are impacted by a reduction-in-force. |
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Relocation expense repayment agreement. |
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May be completed by department representative, UHR, or retiring or resigning employee. Signed resignation letter may be attached in lieu of employee signature.Not intended for transfers, promotions or other changes. |
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Employees are encouraged to complete this form at least thirty days prior to their desired retirement date. Effective date is typically the first of the month. |
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Complete this form when starting, stopping or making a change to your Supplemental Retirement Accounts (SRA), 403b or 457. |
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Complete at retirement for a one-time conversion of unused accumulated sick leave credit in accordance with section 124.39 of the Ohio Revised Code. |
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Administrators and Classified staff, complete to acknowledge that as an Ohio University employee you will not contribute to Social Security. |
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Faculty, complete to acknowledge that as an Ohio University employee you will not contribute to Social Security. |
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Part time classified and administrative hourly employees should use this form if they have more than one job on campus. |
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Student employees should use this form to report time for any pay period they are not in the WorkForce system. |
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Use this form to request unpaid leave of absence (Faculty, Administrative and Classified) |
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Use to request reimbursement for out of network vision costs. |
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| 2020 W4 Withholding Exemption Forms, Federal and State (Kentucky Residents) |
2020 Kentucky and Federal withholding forms:
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| 2020 W4 Withholding Exemption Forms, Federal and State (Ohio Residents) |
2020 Ohio and Federal withholding forms:
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| 2020 W4 Withholding Exemption Forms, Federal and State (West Virginia Residents) |
2020 West Virginia and Federal withholding forms:
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Workplace Alternative Arrangement Agreement (Policy 40.107) Required if relationship exists between employees that work with or under the supervision of one another |
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| Workplace Violence, Complaint Alleging [PDF] | This form must be completed by the complainant’s supervisor or by UHR with the complainant’s input. This form is necessary when an employee reports an incident involving a threat, act of intimidation, violence or other unacceptable behavior being committed by another employee. |