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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| 24 Pay Option Cancellation [PDF] | Faculty can complete this form to cancel their 24 Pay Option Authorization to be effective with the first pay of the academic year. |
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Please report any access issues or barriers, or request an alternative format. |
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Information and resources for changing, updating, or correcting your address. |
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Use this form to request reimbursement for adoption expenses. Upload completed form to the Benefits secure upload site. |
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This form is used to evaluate the performance of AFSCME 1699 bargaining unit employees. |
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Form used when covered member is unable or unwilling to comply with request to provide SSN. Upload completed form to the Benefits secure upload site. |
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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. Additionally, 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. |
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This form is used to change alternative retirement plan providers. Upload completed form to the Benefits secure upload site. |
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You may enroll in or make changes to benefits by accessing the Benefits Self Service module of My Personal Information. This may done during the annual benefits open enrollment or if you experience a family status change. Visit the when can I change page for more information. |
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| Benefits, Request for Benefits Office to add Dependent or Beneficiary [PDF] | Complete this form if you wish to add a dependent or beneficiary that is a current or former Ohio University employee or student OR does not have a SSN. Upload completed form to the Benefits secure upload site. Once processed, benefits will email confirmation and you may access MPI: Benefits Self Service to enroll or update. |
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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. Upload completed form to the Benefits secure upload site. |
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Complete if covering a domestic partner and/or dependents for medical coverage. Upload completed form to the Benefits secure upload site. |
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Complete within 30 days of the termination of a domestic partnership. Upload completed form to the Benefits secure upload site. |
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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. Certain Online Partner Programs are NOT eligible. |
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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. Replaced by ICD. |
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Employee recognition award guidelines. |
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Employee recognition policy Appendix A. To be used for unique employee recognition programs. |
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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 online survey |
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| Extended Furlough Request Form (PDF) | Supervisor completes and submits for approval to request an extended furlough for direct report(s). |
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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: Certification 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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| FMLA: Return to Work Form (OU FMLA #.07) [PDF] | Medical authorization from the health care provider is required for employees returning to work from FMLA/medical leave. This form should be returned to Ohio University Human Resources at least 3 business days prior to the return-to-work date. |
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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 Health care Account. |
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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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| Incumbent Review Request Form [Excel] |
This form is completed by the department when requesting an incumbent review of an employee’s position |
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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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| Leave of Absence Request [Excel] | Use this form to request leave of absence (Faculty, Administrative and Classified Staff) |
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Complete to designate your life insurance beneficiary. Upload completed form to the Benefits secure upload site. |
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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 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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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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| Pay Administration Guidelines Compensation Exception Request Form [Excel] |
This form is completed by the hiring department when requesting compensation outside of the Pay Administration Guidelines. This form must be submitted to Compensation for review and approval, prior to an offer being made to a candidate. |
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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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| Performance Evaluation Form (Web Accessible) [Word] | Performance evaluation including personal goals and self-assessment. More web accessible for use in MS OneDrive. |
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Complete form to provide educational history and licenses and certifications required for position. |
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| Position Classification Appeal Form [Excel] |
This form is completed by an employee, their supervisor, and the Department Head with requesting an appeal to a position’s classification/mapping as a result of an incumbent review. |
| 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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| Prescription Reimbursement Claim [PDF] | Submit to be reimbursed for prescriptions paid out of pocket. |
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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 AFSCME 3200 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 Benefits Self Service module of My Personal Information to make changes. |
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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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Relocation expense repayment agreement. |
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| Request to Donate Sick Leave- AFSCME 3200 [PDF] | Form for AFSCME 3200 bargaining unit staff to donate sick time. |
| Request to Receive Donated Sick Leave- AFSCME 3200 [PDF] | Form for AFSCME 3200 bargaining unit staff to request to receive donated sick time. |
| Request to Donate Vacation Leave [PDF] | Form for benefits eligible administrative staff and faculty to donate vacation time to a paid leave pool. |
| Request to Receive Donated Leave [PDF] | Form for benefits eligible administrative staff and faculty to request to receive donated time from the paid leave pool. |
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May be completed by department representative, UHR, 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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| Student Employee Background Check Request Form [PDF] | Complete for student employees who require additional information verified as part of their employment with Ohio University. Human Resources will initiate a HireRight background check of your choice upon receipt of this form. |
| Supplemental Retirement Plan (403b/ 457b) Vendor Change [PDF] | Complete this form when starting, stopping or making a change to your Supplemental Retirement Accounts (SRA), 403b or 457. |
| Tax Withholding Forms | New employees to the University and current employees who wish to change their withholding status or update their address should complete the form for their state of residence. |
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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 to request reimbursement for out of network vision costs. |
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| W4 Withholding Exemption Forms, Federal and State | New employees to the University and current employees who wish to change their withholding status or update their address should complete the form for their state of residence. |
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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. |