HR Forms

COVID-19 Reporting

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

Employment Documents

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

Benefit Information/Forms

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

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

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

Retirement/Investment Forms

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

WCF Forms

• Workers Compensation Fund Forms
• Workers Comp Official Form 122

Other Forms

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

Benefit Form Submission