HR Forms

COVID-19 Reporting

• Emergency Paid Sick Leave and Family and Medical Leave
• Employee Symptom Reporting
• Other College COVID-19 Information

Employment Documents

• Student Payroll Action Form
• Student New Hire Packet
• Part-time/Hourly Payroll Action Form
• Part-time/Hourly New Hire Packet
• Adjunct Payroll Action Form
• Adjunct New Hire Packet
• Full-time Payroll Action Form

Benefit Information/Forms

• Benefits Summary
• Benefits and Coverage Glossary
• PEHP 2021 Notices
• PEHP Website
• Provider List
• PEHP Enrollment and Change Form
• PEHP Flex Spending
• PEHP Flex Day Care
• Health Savings Employee Contribution (HSA)
• Eyemed Benefit Summary - Eyewear
• Eyemed Benefit Summary - Full
• Opticare Plan - Eyewear
• Opticare Plan - Full
• Consumer Plus Summary of Benefits and Coverage
• STAR HSA Summary of Benefits and Coverage
• Traditional Summary of Benefits and Coverage
• Dental Grids
• Medical Grids
• Employer's Creditable Coverage
• PEHP Creditable Coverage
• Cigna Enrollment Form
• Cigna Enrollment Form - Spanish
• Cigna AD&D
• Cigna AD&D - Spanish
• Cigna Term Life Insurance
• Cigna Term Life Insurance - Spanish
• Cigna Long-Term Disability Insurance
• Cigna Long-Term Disability Insurance - Spanish
• Cigna Short-Term Disability Insurance
• Cigna Short-Term Disability Insurance - Spanish
• Cigna Voluntary Life Insurance
• Cigna Voluntary Life Insurance - Spanish

Evaluations

• Performance Improvement Plan (PIP)

Government Forms

• IRS W4
• I9 Employment Eligibility Verification

New Position Forms

• Faculty/Staff Position Request
• Faculty/Staff Salary Offer
• Personal Information Form

Payroll

• Stop/Add Payroll Deductions
• Payroll Donation Deduction
• Comp Time Earned (Overtime for Non-Exempt Employees)
• HSA Employee Contributions
• Adjunct MOU
• Direct Deposit

Retirement/Investment Forms

• URS Website
• URS Forms
• TIAA Address Change
• TIAA 403(b), 457(b), ROTH 403(b) Salary Reduction Agreement

WCF Forms

• Workers Compensation Fund Forms
• Workers Comp Official Form 122

Other Forms

• Background Check Consent
• Cell Phone Request and Procedures
• Activity Center Pass
• Richfield SnowFit
• Independent Contractor/Professional Service Agreement
• Independent Contractor IRS Information
• Tuition Reduction
• Classes During Work Hours
• Volunteer Service Agreement
• Confidentiality Agreement
• Notice of Separation
• Reasonable Accommodation Request
• Aflac Voluntary Benefits Guide

Benefit Form Submission