Ohio University

Forms

If you are not able to find a form by filtering please email hrweb@ohio.edu.

Form Description

24 Pay Option Authorization [PDF]

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. 

Accessibility, Report Issue

Please report any access issues or barriers, or request an alternative format.

Address Change

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.

Adoption Benefit Financial Reimbursement Form [PDF]

Use this form to request reimbursement for adoption expenses.

AFSCME Performance Evaluation [Excel]

This form is used to evaluate the performance of classified bargaining unit employees.

Anthem Social Security Number Exception

Form used when covered member is unable or unwilling to comply with request to provide SSN.

Appointment Form [Excel]

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.

ARP Vendor Change [PDF]

This form is used to change alternative retirement plan providers.

Award Request, Employee [Excel]

Form to request gift, gift certificate, or Bobcat Cash for an employee.

Benefits Enrollment

You may enroll in or make changes to benefits by accessing the Self Service Benefits module of My Personal Information.

Classification Appeal [PDF]

Used to appeal a classification.

Complaint Alleging Workplace Violence [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.

Dental Claim [PDF]

This form can be submitted by your dentist for a pre-treatment estimate or a claim for actual services.

Direct Deposit [PDF]

Use this form to start or change Direct Deposit.

Disability, OPERS

Link to forms required to apply for long term disability with OPERS.

Disability, STRS

Call STRS at 1-888-227-7877 to request forms required to apply for long term disability.

Disability, UNUM Long Term

Use this form to submit claims for UNUM Long Term Disability: employee statement, authorizations, attending physician statement, etc.

Disability, UNUM Short Term [PDF]

Instructions for submitting a Short Term Disability claim.

Disability, Voluntary Self-Identification

Access MPI: Personal Information to voluntarily disclose a disability.

Domestic Partner, Affidavit [PDF]

Complete to establish domestic partnership to cover as a dependent for medical and/or educational benefits as well as sick leave.

Domestic Partner, Enrollment [PDF]

Complete if covering a domestic partner and/or dependents for medical coverage.

Domestic Partner, Statement of Termination [PDF]

Complete within 30 days of the termination of a domestic partnership.

Early Retirement Incentive Plan (ERIP) Rehire Invitation VP University Outreach and Regional Campuses [PDF]

Completed by regional campuses when requesting the rehire of a retiree.

Educational Benefit, Employee [PDF]

**This form is currently under revision. Employees should complete this form each semester enrolled in classes to apply for the tuition waiver. Must secure supervisor and department head signatures.

Educational Benefit, Qualified Dependents [PDF]

To be completed by the employee each academic year to apply for the tuition waiver for qualified dependents.

Email Access Request [PDF]

Request for Access to IT Resources- required to formally request any type of departmental access to another user's OHIO accounts or systems

Emergency Service Leave Request [PDF]

Employees are eligible for 40 hours of emergency service leave in a calendar year. This includes volunteer firefighters, paramedics, EMT and First Responders.

Employee Award Request [Excel]

Employee award request form for a gift, gift certificate, or Bobcat Cash

Employee Recognition Award Guidelines [PDF]

Employee recognition award guidelines.

Employee Recognition, (Appendix A) [PDF]

Employee recognition policy Appendix A.

Evidence of Insurability, Life Insurance [PDF]

Complete if requesting supplemental life insurance in amount above guaranteed issue. Submit directly to Securian Life.

Existing Student Employee Information Sheet [PDF]

Student employee information

Exit Interview Questionnaire [PDF]

Exit Interview general information questionnaire

Express Scripts Mail Order

Register online to complete form to receive home delivery of mail order prescription(s).

Express Scripts Reimbursement

Complete this form to be reimbursed for a prescription drug that you paid out of pocket.

FMLA: Application for Family or Medical Leave (OU FMLA #.01) [Excel]

Employee completes and submits to department when requesting Family Medical Leave.

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.

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.

FMLA: Designation Notice Under FMLA (OU FMLA #.03B) [Excel]

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.

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.

FMLA: Forms Overview [PDF]

Forms and Guidelines information for FMLA.

FMLA: Medical Certification Statement (Family Member or Caregiver Leave for Injured or Ill Service Member (OU FMLA #.05) [Excel]

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.

FMLA: Notice to Employer (OU FMLA #.02) [PDF]

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.

Flexible Spending Account, Dependent Care, Wageworks

Complete this form to request reimbursement from your WageWorks Dependent Care Account.

Flexible Spending Account, Healthcare, Wageworks

Complete this form to request reimbursement from your WageWorks Healthcare Account.

Flexible Work Schedule Agreement Form [PDF]

Used when administrators request a change to their regularly scheduled work hours arrangement.

Flexplace Agreement Form [PDF]

Used when administrators request a flexplace arrangement

Fraud Reporting Form [PDF]

Acknowledgement of receipt of Auditor of State fraud reporting system information.

FTE Calculator [Excel]

Academic FTE chart for overload and summer appointments.

FTE Reduction, Voluntary [PDF]

Voluntary short-term FTE Reduction Agreement for administrative staff.

Home Office Safety Guidelines and Agreement Form [PDF]

Home office safety guidelines and agreement form.

Incident Report (Workers Compensation) [PDF]

To be completed by supervisor and employee immediately after a work-related injury, illness or incident.

International Claim, Anthem [PDF]

Form used to submit institutional and professional claims for benefits for covered services received outside the US, Puerto Rico and the US Virgin Islands.

Interviewer Evaluation [PDF]

This form is a guide for interviewers to allow them to objectively evaluate the candidate’s suitability for employment.

IT-4NR Reciprocity Tax

Employee Statement of Residency in reciprocity state (Indiana, Kentucky, West Virginia, Michigan or Pennsylvania).

Life Insurance Beneficiary [PDF]

Complete to designate your life insurance beneficiary.

Medical Claim, Anthem [PDF]

Use to submit a medical claim form to Anthem.

New Employee Tax Compliance Notification [PDF]

New employees who are not citizens or permanent resident aliens of the United States are required to complete this form.

New Hire Checklist for Departments [Excel] Departments/Supervisors are encouraged to utilize this checklist for new employees.

New Hire Notification STRS

To be completed by new faculty withing ten days of start date.

New Student Employee Pre-Hire Form [PDF]

Supervisors should provide this form to new student employee at the time of hire.

Non Employee Incident Report [PDF]

This form should be submitted within 24 hours of the injury/ incident of a non employee.

Occupational Injury, Sick Leave or Leave of Absence [PDF]

Occupational Injury/Illness, option of sick leave or unpaid medical leave of absence.

OPERS Employee Information Sheet [PDF]

OPERS Employee Information Sheet- replaces current Personal History Record for OPERS Members

OPERS Exemption Form

OPERS optional exemption as a student

Organ Donation Leave [PDF]

This form should be completed if requesting leave for the purpose of organ donation.

Paid Time Off Request (Faculty and Staff)

Faculty and administrations should access the MPI: Absence Management link to request paid time off.

Parental Leave [Excel]

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.

Parental Leave Partial Time Off / Flex Time [PDF]

Complete if requesting partial time off or flex time parental leave.

Payroll Expense Accounting Correction (PEDS) [Excel]

Payroll Expense Accounting Correction form.

Performance Evaluation Form [Word]

Performance evaluation including personal goals and self-assessment.

Personal Data Profile [Excel]

Complete form to provide educational history and licenses and certifications required for position.

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.

Position Description [Word]

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.

Position Modification [Excel]

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. 

Prior State Service (Request for Transfer) [Excel]

Submit to previous employee to request transfer of prior state service credit and sick leave.

Probationary Evaluation, Classified Non Bargaining [Word]

Used to evaluate performance of classified non bargaining unit employees during their probationary period.

Qualifying Benefits Life Event

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.

Reciprocity Agreement

To be completed by residents of Indiana, Kentucky, West Virginia, Michigan or Pennsylvania for tax purposes. 

Record of Taxable Uniform [Excel]

CFAO or their delegate should forward a copy of this form to the employment tax accountant, payrolltax@ohio.edu.

Reduction-in-Force Disclosure and Election

Form for administrative employees and classified staff who are impacted by a reduction-in-force.

Relocation Expense Repayment Agreement [PDF]

Relocation expense repayment agreement.

Resignation/ Separation Form [PDF]

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.

Retirement Separation [PDF]

Complete at retirement; effective date is typically the first of the month.

Salary Reduction Agreement [Excel]

Complete this form when starting, stopping or making a change to your Supplemental Retirement Accounts (SRA), 403b or 457.

Sick Leave Conversion [Excel]

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.

Statement Concerning your Employment in a job not covered by Social Security (Administrators, Classified and Bargaining Unit) SSA-1945 [PDF]

Administrators and Classified staff, complete to acknowledge that as an Ohio University employee you will not contribute to Social Security.

Statement Concerning your Employment in a job not covered by Social Security (Faculty) SSA -1945 [PDF]

Faculty, complete to acknowledge that as an Ohio University employee you will not contribute to Social Security.

Time Sheet- Classified [Excel]

Part time classified and administrative hourly employees should use this form if they have more than one job on campus.

Time Sheet- Student [Excel]

Student employees should use this form to report time for any pay period they are not in the WorkForce system.

Unpaid Leave of Absence Request [Excel]

Use this form to request unpaid leave of absence (Faculty, Administrative and Classified)

Vision Out of Network Reimbursement, VSP [PDF]

Use to request reimbursement for out of network vision costs.

W4 Withholding Exemption Forms, Federal and State (Kentucky Residents)

Kentucky and Federal withholding forms:

W4 Withholding Exemption Forms, Federal and State (Ohio Residents)

Ohio and Federal withholding forms:

W4 Withholding Exemption Forms, Federal and State (West Virginia Residents)

West Virginia and Federal withholding forms:

Workplace Alternative Arrangements Agreement Form [PDF]

Workplace Alternative Arrangement Agreement (Policy 40.107) Required if relationship exists between employees that work with or under the supervision of one another