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Human Resources Forms

Below is a comprehensive listing of Human Resources related forms

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This table contains downloadable forms and documents
Form or
Document Name
Description

PDF

Word/Excel Link
Benefits
Address Change   (.pdf, 77kb) (.doc, 41kb)  
Benefits at a Glance - UUP Faculty FT Brief summary of your benefits based on University affiliation.   (.doc, 56kb)  
Benefits at a Glance - UUP Faculty PT Brief summary of your benefits based on University affiliation.   (.doc, 56kb)  
Benefits at a Glance - UUP Professional FT & Library Faculty Brief summary of your benefits based on University affiliation.   (.doc, 55kb)  
Benefits at a Glance - UUP Professional PT & Library Faculty Brief summary of your benefits based on University affiliation.   (.doc, 57kb)  
Benefits at a Glance - MC Professional Brief summary of your benefits based on University affiliation.   (.doc, 57kb)  
Benefits at a Glance - MC Classified Brief summary of your benefits based on University affiliation.   (.doc, 54kb)  
Benefits at a Glance - CSEA Brief summary of your benefits based on University affiliation.   (.doc, 52kb)  
Benefits at a Glance - CSEA (Hourly) Brief summary of your benefits based on University affiliation.   (.doc, 52kb)  
Benefits at a Glance - PEF Brief summary of your benefits based on University affiliation.   (.doc, 54kb)  
Benefits at a Glance - NYSCOPBA (Non Arbitration) Brief summary of your benefits based on University affiliation.   (.doc, 51kb)  
Benefits at a Glance - PBA-NYS Brief summary of your benefits based on University affiliation.   (.doc, 53kb)  
 Choices for 2014 - Ratified For Employees of the State of New York who are unrepresented or in Negotiating Units that have agreements/awards with New York State effective October 1, 2011 or later, Employees of Participating Employers, and for COBRA enrollees with their NYSHIP benefits  (.pdf, .98mb)    
CSEA Dental Claim For CSEA represented staff to submit dental expenses to the union's employee benefit fund (.pdf, 1.9mb)    
CSEA Full-Time Student Verification To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by the CSEA Benefit Fund (.pdf, 523kb)    
CSEA Prescription Drug
Co-Pay Reimbursement
Claim form for CSEA benefits fund covered prescription drug co-pay expenses (.pdf, 120kb)    
Davis Vision Student Verification Form To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by UUP, MC, PBA-NYS, NYSCOPBA, and PEF dental benefits (.pdf, 120kb)    
Dependent Care Advantage Account
Reimbursement (Flexible Spending)
To request reimbursement for dependent care related expenses from your existing flexible spending account. Daycare or elder care expenses for example. (.pdf, 36.3kb)    
 Domestic Partner
Application for Benefits
Affidavit of domestic partnership and financial interdependence. For employees in the following bargaining units: CSEA, UUP, PEF, GSEU, PBA, M/C, NYSCOPBA (.pdf, 71.6kb)    
Domestic Partner Dependent
Tax Affidavit
Statement declaring that your domestic partner federally qualifies to be claimed as your income tax dependent (.pdf, 58.3kb)    
Domestic Partner Termination of Partnership To request a termination of a domestic partnership (.pdf, 52.1b)    
Domestic Partnership Instructions Instructions on creating a domestic partnership (.pdf, 84.5kb)    
Empire Plan Non-Participating
Claim
To request reimbursement for expenses from a non-participating health care provider (.pdf, 52.4kb)    
Empire Plan Pharmacy
Reimbursement Claim
To request reimbursement for prescription drug expenses when paid out of pocket (.pdf, 73.6kb)    
Empire Plan Pharmacy Mail Order Form To request mail order of prescription drugs (.pdf .71.3kb)    
EyeMed Full-Time Student
Verification
To confirm full time student status for dependents age 19-24 when using the EyeMed vision plan. For M/C, PEF, Council 82 and NYSCOPBA only. (.pdf, 37.2kb)    
GA/TA Employment & Benefits
Checklist - New
For new graduate and teaching assistants      link
GA/TA Employment & Benefits
Checklist - Returning
For returning or rehired graduate and teaching assistants      link
GHI Dental Claim To request reimbursement for dental claims. For GSEU, M/C, PEF, Council 82 and NYSCOPBA only (.pdf, 53.2kb)    
GHI Full-Time Student
Verification
To confirm full time student status for dependents age 19-24. M/C, PEF, Council 82 and NYSCOPBA only. (.pdf, 90.1kb)    
GSEU Health Insurance
Transaction Form (PS-404G)
For Graduate Student Employee Union student employee health plan enrollment or changes (.pdf, 31.6kb)    
GSEU Health Insurance Enrollment
Instructions for PS-404G
Instructions for completing the form PS-404G GSEU Health Insurance Enrollment Form (.pdf, 13.7kb) (.doc, 33.8kb)  

GSEU Health Insurance Summer Continuation Notice

GSEU Health Insurance Summer Continuation Notice   (.doc, 32kb)  
Health Care Spending
Account Reimbursement (Flexible Spending)
To request reimbursement for health care related expenses from your existing flexible spending account. (.pdf, 28.5kb)    
Health Insurance Transaction Form (PS-404) For health insurance enrollment and changes for Faculty and Staff (.pdf, 28.5kb)    
Health Insurance Transaction Form Instructions (PS-404) Instructions for completing the health insurance enrollment and changes form for Faculty and Staff (.pdf, 28.5kb)    
Health Insurance Opt Out Attestation (PS-409) Form to opt out of health insurance coverage (.pdf, 44kb)    
Medco Plan Mail-In Prescription
Request
Mail order prescription request form (.pdf, 50.9kb)    
NYPERL - Employee Notice and
Fact Sheet
New York State Public Employee Long-Term Care Insurance Plan (.pdf, 62kb)    
Salary Reduction Agreement To request a new or change in a voluntary supplemental retirement account deduction amount (.pdf, 50kb) (.doc, 27kb)  
Space Available Program
Application and Instructions
For UUP represented faculty/staff only; allows employees in the UUP bargaining unit to take one course per semester provided there is space available in the desired course     Link
State University Tuition Waiver Program Application and Instructions Request reimbursement for all or part of an employee's tuition cost.  (.pdf, 16kb)    
UUP Benefit Fund Address
Change
For employees represented by UUP (.pdf, 57.7kb)    
UUP Benefit Trust Fund
Enrollment
Dental and vision enrollment for United University Professions (UUP) represented employees (.pdf, 56.3kb)    
UUP Benefit Trust Fund Marital
Status or Dependent Change
To notify UUP Benefit Trust Fund of marital status or dependent changes for dental and vision benefits (.pdf, 66.8kb)    
UUP Delta Dental Claim For UUP represented faculty/staff to submit dental claims effective 4/1/2008 (.pdf, 56.7kb)    
UUP Full-Time Student
Verification
For dependents of UUP represented faculty/staff between ages 19 and 25 (.pdf, 47.4kb)    
UUP Group Life Beneficiary
Designation
For all faculty/staff represented by UUP; First UNUM Life Insurance Co. (.pdf, 27.9kb)    
UUP and MC Unclassified Long Term Disability Application For MC unclassified and UUP professionals (.pdf, 334kb)    
Where to Call A list of phone numbers and links to state agencies and other benefits providers   (.doc, 52.5kb)  
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Form or
Document Name
Description

PDF

Word/Excel Link

Employment

Alternate Work Options Flexible work schedule options that may be of interest to staff members. (.pdf, 78kb)    
Email Information for New Faculty/Staff Information on how to access your new email address at Binghamton University (.pdf, 23kb)    
Employee Information Form Personal and demographic information; required for all new hires and changes in status (.pdf, 5.1mb) (.doc, 1.1mb)  
I-9 Employment Eligibility To document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. (.pdf, 39.8mb)    
State Employee Statement in Lieu of Oath Certifies that a State employee has read and understands the NYS Public Officer's Law. Required for all new faculty/staff and graduate/teaching assistants and those changing official budget titles. (.pdf, 23.4mb)    
PA-81 Internal Application for
Promotion
For classified service, non-competitive, labor class promotion. Employee's status must be permanent or contingent permanent. (.pdf, 48.7kb) (.doc, 67.1kb)  
Phased Retirement Request For UUP and Management Confidential Staff requesting to work less than full-time as near retirement (.pdf, 34.0kb)    
Prior Service Credit Request for Faculty Prior service request form for faculty hired in a tenure track position (.pdf, 27.6kb) (.doc, 236kb)  
Professional Employee Promotion/Reclassification/Salary Increase Request For non-teaching, UUP represented, professional staff. Requests accepted during appropriate window. (.pdf, 83kb) (.doc, 85.5kb)  
Faculty/Staff Handbook Receipt Acknowledgment of receipt of the Faculty and Staff Handbook information. (.pdf, 107kb)    
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Form or
Document Name
Description

PDF

Word/Excel Link

Hiring and Recruitment

ADA Cover Memo Americans with Disabilities Act Memo (.pdf, 39.2kb) (.doc, 48.6kb)  
ADA Position Analysis Americans with Disabilities Act position analysis (.pdf, 18.7kb) (.doc, 35.8kb)  
ADA Position Description Americans with Disabilities Act position description (.pdf, 10.5kb) (.doc, 27.1kb)  
Affirmative Action / Office of Diversity, Equity & Inclusion (ODEI)
(Parts I, 2 and 3)
Notice of vacancy and recruitment plan. For search committee use. Submit to Office of Diversity, Equity & Inclusion for approval (.pdf, 31.1kb) (.doc, 78.3kb)  

Binghamton University
Education History Addendum

Attach as needed to the employment application form (.pdf, 68.3kb) (.doc, 10.3mb)  
Binghamton University
Employment Application
Application for employment (.pdf, 10.5mb) (.doc, 24.8mb)  
Binghamton University
Employment History Addendum
Attach as needed to the employment application form (.pdf, 61.4kb) (.doc, 97.3kb)  
Professional Vacancy Worksheet To assist Human Resources with the posting of a professional vacancy (.pdf, 50.9kb) (.doc, 59.4kb)  
Recruitment Links For a list of various sources to advertise with for a position you are hiring for (.pdf, 18kb) (.doc, 20kb)  
Verification of Candidate
Credentials
For professional vacancy search committee use (.pdf, 45.8kb) (.doc, 85.0kb)  
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Form or
Document Name
Description

PDF

Word/Excel Link
hr masters & Coordinators
2013-2014 Faculty, Staff & GA/TA HR Transaction Processing Deadlines Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls (.pdf, 126.3kb) (.xls, 30.0kb)  
2014-2015 Faculty, Staff & GA/TA HR Transaction Processing Deadlines Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls (.pdf, 11.0kb) (.xls, 12.0kb)  
2013-2014 Student Assistant & Federal College Work Study HR Transaction Processing Deadlines Deadlines for HR transaction processing for the Student Assistant and Federal College Work Study payrolls (.pdf, 43.0kb) (.xls, 22.0kb)  
2013-2014 Student Assistant & Federal College Work Study Paycheck Dates (For Students) Student Assistant & Federal College Work Study Paycheck Dates   (.xls, 36.0kb)  
Summer 2014 Student Assistant & Federal College Work Study HR Transaction Processing Deadlines Deadlines for HR transaction processing for the Student Assistant and Federal College Work Study payrolls (.pdf, 42.0kb) (.xls, 30.0kb)  
Summer 2014 Student Assistant & Federal College Work Study Paycheck Dates (For Students) Student Assistant & Federal College Work Study Paycheck Dates (.pdf, 101.0kb) (.xls, 41.0kb)  
2014-2015 Student Assistant & Federal College Work Study HR Transaction Processing Deadlines Deadlines for HR transaction processing for the Student Assistant and Federal College Work Study payrolls (.pdf, 43.0kb) (.xls, 28.0kb)  
2014-2015 Student Assistant & Federal College Work Study Paycheck Dates (For Students) Student Assistant & Federal College Work Study Paycheck Dates (.pdf, 95.0kb) (.xls, 42.0kb)  
2014-2015 Faculty, Staff & GA/TA Lag Payroll Calendar Payroll calendar for Faculty, Staff and GA/TA lag payrolls     Link
2013-2014 Obligation & Payroll Appointment Dates Document outlining obligation and appointment dates for all payrolls (.pdf, 46kb) (.xls, 14kb)  
2014-2015 Obligation & Payroll Appointment Dates Document outlining obligation and appointment dates for all payrolls (.pdf, 14kb) (.xls, 45kb)  
Agreement to Protect Confidential Information Agreement to protect confidential information (.pdf, 56.6kb)    
Appointing to Faculty Titles Instructions on how to appoint to faculty titles (.pdf, 27.2kb)    
Dual Employment Form (AC-1588) Form to be completed by employees working for multiple state agencies (.pdf, 14.9kb)    
Extra Service Checklist Checklist of forms to be completed to process extra service (.pdf, 29.5kb) (.doc, 56.8kb)  
Extra Service Payroll Voucher (AC-873) Time record to be completed for Dual Employment Extra Service (.pdf, 14.0kb)    
Extra Service Policy Extra service policy     Link
Extra Service Request Form

Form to be completed by departments paying for on campus extra service for state employees

(.pdf, 50.0kb) (.doc, 22.9mb)  
UP-8 For UUP employees to request approval for extra service at another state agency (.pdf, 12.1kb) (.doc, 55.3kb)  
UP-6

For Management Confidential employees to request approval for extra service at another state agency

(.pdf, 13.7kb) (.doc, 55.3kb)  
HR Forms Training PowerPoint Training manual for HR Forms (.ppt, 1645kb)    
HR Forms "Which Form Do I Use" Instructions for which HR Form to use (.pdf, 56kb)    
Organization Request Form Request form for creating/updating organizations (.pdf, 108 kb)  (.doc, 18 kb)  
Position Request Form for State Payrolls Position request form for all payrolls     Link
Summer Session Appointment Instructions Instructions for summer session appointments (.pdf, 17.1kb) (.doc, 32.8kb)  
Winter Session Appointments Instructions Instructions for winter session appointments (.pdf, 22.9kb) (.doc, 27.6kb)  
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Immigration
Extend H-1B Questionnaire for department Questionnaire for extension of H-1B for departments (.pdf, 9.3kb)    
Extend H-1B Questionnaire for employee Questionnaire for extension of H-1B for employees (.pdf, 11.2kb)    
Immigration Process for department Flow chart of immigration process for departments (.pdf, 74.4kb)    
Initial H-1B Questionnaire for department Questionnaire for initial H-1B for departments (.pdf, 23kb)  (.doc, 35kb  
Initial H-1B Questionnaire for employee Questionnaire for initial H-1B for employees (.pdf, 23mb)  (.doc, 34kb)  
Tax Withholding Guide for International Students and Scholars 2014 tax withholding guide for International Students and Scholars (.pdf, 14kb) (.doc, 39kb)  
Visa Options Common visa categories used to hire international employees (.pdf, 79kb) (.doc, 122mb)  
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Leaves
Confidential Medical Statement To be completed by a health care provider (.pdf, 41.7kb)    
Confidential Medical Statement
(Work Related Injury)
To be completed by a health care provider for a work-related injury (.pdf, 42.1kb)    
Confidential Medical Statement (CSEA only) To be completed by a health care provider for non work-related injuries (CSEA only) (.pdf, 39.8kb)    
FMLA - Employee's Serious Health Condition Family and Medical Leave Act request form (pdf)     Link
FMLA - Family Member's Serious Health Condition Family and Medical Leave Act request form (pdf)     Link
FMLA - FMLA Illness of Covered Servicemember for Military Family Leave Family and Medical Leave Act request form (pdf)     Link
FMLA - FMLA Qualifying Exigency for Military Family Leave Family and Medical Leave Act request form (pdf)     Link

Leave Donation (for all
bargaining units)

To donate vacation leave to cover an "eligible" employee's sick leave (.pdf, 15.1kb) (.doc, 31.2kb)  
Title F Leave Request for Faculty See Faculty/Staff handbook section IV.B.2. Leave of Absence (Title F Leave)   (.doc, 40.5kb)  
Title F Leave Request for
Professionals
For UUP represented professional staff   (.doc, 26.1kb)  
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Misc.
Label Request Online form to request pre-printed labels or paper for on-campus mailing.  You may be prompted to sign in with your User ID and PODS password.     Link
STAR Recognition Program
Nomination
To nominate a campus employee for the STAR employee recognition award (.pdf, 20.7kb) (.doc, 24.2mb)  
Workplace Violence Policy Workplace violence policy (.pdf, 60.8kb) (.doc, 60.9kb)  
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Payroll
Direct Deposit (AC-2722) For new, changes or deletions of direct deposit of your payroll into your bank account(s) (.pdf, 26.4mb)    
Direct Deposit Reactivate To reactive an existing direct deposit which may have lapsed. May NOT be used to start a new direct deposit allocation. (.pdf, 38.9kb) (.xls, 52.7kb)  
Federal Tax Form W-4 To withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. (.pdf, 16.8mb)    
Honoraria Payment FAQ's Frequently asked questions regarding honoraria payments   (.doc, 26.1kb)  
Honoraria Payment Policy Policy regarding honoraria payments to faculty and professional staff     Link
New York State Certificate of
Nonresidence and Allocation of
Withholding Tax (IT-2104.1)
New York State, City of New York, and City of Yonkers Certificate of Nonresidence and Allocation of Withholding Tax     Link
New York State Tax Certificate
of Exemption
(IT-2104-E)
To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if applicable)     Link
New York State Tax Form
(IT-2104)
To withhold the correct New York State income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes     Link
Nonresident Alien FICA Refund Request Nonresident Alien FICA Refund Request (.pdf, 30.7kb)    
SUNY Charitable Giving
Campaign Payroll Deduction
You can give to the State University of New York campus of your choice through the SUNY Charitable Giving Campaign. (.pdf, 54.5kb)    
Treasury Direct Direct Deposit Form Treasury Direct Direct Deposit Form ONLY (.pdf, 31kb)    
Unclaimed Check Policy Unclaimed check policy (.pdf, 21.5kb) (.doc, 32.3kb)  
W2 Reissue Request Form to request a W-2 (.pdf, 50.4kb)    
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Performance Management
Classified Service Performance
Program/Evaluation
Performance program and evaluations for all classified service staff (.pdf, 12.0mb) (.doc, 95.2kb)  
Professional Employee
Evaluation
For non-teaching, UUP represented professional staff (.pdf, 10.7 mb) (.doc, 84.5kb)  
Professional Employee
Performance
Program
For non-teaching, UUP represented professional staff (.pdf, 66.9kb) (.doc, 24.7mb)  
Professional Employee
Self-Evaluation
For non-teaching, UUP represented professional staff (.pdf, 44.9kb) (.doc, 24.3mb)  
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Retiree Services (forms for retired employees)
Binghamton University Service Preference Checklist for Binghamton University retirees      Link
Retire Contact Information Form Contact information form for Binghamton University retirees'      Link
Retiree Survey Survey for Binghamton University retirees'      Link
Retiree Volunteer Form Form for Binghamton University retiree volunteers      Link
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Form or
Document Name
DescriptionPDFWord / Excel
HTML / Link
Retirement (forms for current employees)
ERS Address Change
(RS-5512)
Change of address form for active Employees' Retirement System members only (not retirees) (.pdf, 24.6kb)    
ERS Beneficiary Designation
(RS 5127-I)
Designation of beneficiary for active Employees' Retirement Systems members only (not retirees) (.pdf, 74.2kb)    
ERS Loan Application
Tiers 1 & 2 (RS-5025)
For Tier 1 and Tier 2 Employees' Retirement System members to request a loan     Link
ERS Loan Application
Tiers 3 & 4 (RS-5025-A)
For Tier 3 and Tier 4 Employees' Retirement System members to request a loan     Link
ERS Membership Application Employees' Retirement System membership registration form     Link
ERS Name Change
(RS-5483-I)
To notify the Employees' Retirement System of a legal name change (.pdf, 37.2kb)    
Retirement System Option for Student Employees Form to acknowledge retirement system options for student employees (.pdf, 60.2kb)    
TRS Beneficiary Designation
(NET-11.4)
Designation of beneficiary for active Teachers' Retirement System members only (not retirees) (.pdf, 52.6kb)    
TRS Loan Application
(LON-26)
For Teachers' Retirement System members to request a loan     Link
TRS Membership Application Teachers' Retirement System membership registration form     Link
TRS Member Name/Address Change To notify the Teachers' Retirement System of a legal name/address change     Link
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Time and Attendance
Accruals by Bargaining Unit Accrual rates for vacation/annual, sick and personal leave accruals      Link
Classified Annual
Timesheet (CLS-ANN)
For classified service staff with an annual pay basis (.pdf, 143kb) (.doc, 10.1mb)  

Classified Hourly with
Attendance Rules Timesheet
(CLS-HRYA)

For classified service staff with an hourly pay basis and attendance rules coverage (.pdf, 37.3kb) (.doc, 13.7mb)  
Classified Hourly without Attendance Rules Timesheet (CLS-HRY) For classified service staff with an hourly pay basis and NO attendance rules coverage (.pdf, 14.7kb) (.doc, 91.6kb)  
Faculty Timesheet Timesheet for all UUP represented faculty     Link
Federal College Work Study (28023)
Timesheet
Timesheet for students of the federal college work-study payroll (28023) only (.pdf, 11.6mb) (.doc, 25.8mb)  
Graduate and Teaching
Assistant Timesheet
Timesheet for graduate and teaching assistants on the 28029 payroll only.     Link
Management Confidential
(M/C) Time & Attendance
Log-in to SUNY.edu for Time & Attendance for all Management/Confidential staff     Link
Professional Annual and
College Year Staff Time & Attendance
Log-in to SUNY.edu for Time & Attendance for UUP represented professional staff with an Annual or College Year obligation     Link
Professional Non-Exempt
Timesheet
For UUP represented professional staff designated as Non-Exempt according to Fair Labor Standards Act (FLSA)     Link
Professional Hourly Staff
Timesheet (UUP-HRY)
For UUP represented professional staff with an hourly pay basis (.pdf, 17.3kb) (.doc, 25.9mb)  
Student Assistant (28021)
Timesheet
Timesheet for students on the student assistant payroll (28021) only (.pdf, 11.8mb) (.doc, 28.5mb)  
Classified Accrual Instructions Accrual instructions for classified employees (.pdf, 56.8kb)    
Faculty Accrual Instructions Accrual instructions for faculty (.pdf, 52.2kb)    
Graduate Student Accrual Instructions Accrual instructions for graduate students (.pdf, 48.8kb)    
M/C Professional Accrual Instructions Accrual instructions for M/C professional employees (.pdf, 79.8kb)    
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Form or
Document Name
Description

PDF

Word / Excel
HTML / Link
Workers Compensation/Accidents/Accommodation
Accident or Injury Reporting (CS-13) To report an accident or injury on campus property/work-related (.pdf, 32.30mb)    
Accident or Injury Reporting
Procedures
A document outlining the necessary steps for reporting an accident at work (.pdf, 22kb) (.doc, 44kb)  
Confidential Medical Statement for Work-Related Disability A document to report a work related disability (.pdf, 86.3kb)    
Employee Accident Report Employee accident and investigation report (.pdf, 12.6kb) (.doc, 25.6kb)  
Reasonable Accommodation Request for Reasonable Accommodation (.pdf, 19kb) (.doc, 67kb)  
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Last Updated: 4/18/14