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    Human Resources
    Grosvenor West 103
    1 Ohio University
    Athens, OH 45701
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    Human Resources

    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. 
    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.
    Accessibility, Report Issue Please report any access issues or barriers, or request an alternative format.
    Address Change Information and resources for changing, updating, or correcting your address. 
    Adoption Benefit Financial Reimbursement Form [PDF] Use this form to request reimbursement for adoption expenses. Upload completed form to the Benefits secure upload site .
    AFSCME 1699 Performance Evaluation [PDF] This form is used to evaluate the performance of AFSCME 1699 bargaining unit employees.
    Anthem Social Security Number Exception [PDF] 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 .
    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.  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. 
    ARP Vendor Change [PDF] This form is used to change alternative retirement plan providers. Upload completed form to the Benefits secure upload site .
    Benefits Enrollment 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.
    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.
    Dental Claim [PDF] This form can be submitted by your dentist for a pre-treatment estimate or a claim for actual services.
    Direct Deposit 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 [PDF] 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. Upload completed form to the Benefits secure upload site .
    Domestic Partner, Enrollment  [PDF] Complete if covering a domestic partner and/or dependents for medical coverage. Upload completed form to the Benefits secure upload site .
    Domestic Partner, Statement of Termination [PDF] Complete within 30 days of the termination of a domestic partnership. Upload completed form to the Benefits secure upload site .
    Educational Benefit, Employee [PDF] 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. Replaced by ICD.
    Employee Work Related Incident Form (Workers Compensation) [PDF] To be completed by supervisor and employee immediately after a work-related injury, illness or incident.
    Employee Recognition Award Guidelines [PDF] Employee recognition award guidelines.
    Employee Recognition, (Appendix A) [PDF] Employee recognition policy Appendix A. To be used for unique employee recognition programs.
    Evidence of Insurability, Life Insurance (EOI) [PDF] Complete if requesting supplemental life insurance in amount above guaranteed issue. Submit directly to Securian Life.
    Existing Student Employee Information Sheet Student employee information
    Exit Interview Survey Exit Interview general information online survey
    Extended Furlough Request Form (PDF) Supervisor completes and submits for approval to request an extended furlough for direct report(s). 
    FMLA: Application for Family or Medical Leave (OU FMLA #.01) [Excel] Employee completes and submits to department when requesting Family Medical Leave.
    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.
    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.
    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.
    Flexible Spending Account, Dependent Care, Wageworks Complete this form to request reimbursement from your WageWorks Dependent Care Account.
    Flexible Spending Account, Health care, Wageworks Complete this form to request reimbursement from your WageWorks Health care Account.
    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.
    Incumbent Review Request Form [Excel] This form is completed by the department when requesting an incumbent review of an employee’s position
    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.
    Leave of Absence Request [Excel] Use this form to request leave of absence (Faculty, Administrative and Classified Staff)
    Life Insurance Beneficiary [PDF] Complete to designate your life insurance beneficiary. Upload completed form to the Benefits secure upload site .
    Life Insurance Conversion Call Minnesota Life at 1-866-365-2374 to receive information on converting life insurance if you separate employment.
    Medical Claim, Anthem [PDF] Use to submit a medical claim form to Anthem.
    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 within ten days of start date.
    New Student Employee Pre-Hire Form 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.
    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.
    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.
    Payroll Expense Accounting Correction (PEDS) [Excel] Payroll Expense Accounting Correction form.
    Performance Evaluation Form [Word] Annual performance evaluation including personal goals.
    Employee Performance Self Assessment [Word] Employee self assessment for use within our performance management system.
    Personal Data Profile [Excel] Complete form to provide educational history and licenses and certifications required for position.
    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.
    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.
    Prescription Reimbursement Claim [PDF] Submit to be reimbursed for prescriptions paid out of pocket.
    Prior State Service (Request for Transfer) [Excel] Submit to previous employer to request transfer of prior state service credit and sick leave.
    Probationary Evaluation, AFSCME 3200 Bargaining Unit [Word] Used to evaluate performance of AFSCME 3200 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 Benefits Self Service module of My Personal Information to make changes.
    Record of Taxable Uniform [Excel] CFAO or their delegate should forward a copy of this form to the employment tax accountant, payrolltax@ohio.edu .
    Relocation Expense Repayment Agreement [PDF] Relocation expense repayment agreement.
    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.
    Resignation/ Separation Form [PDF] 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.
    Retirement Plan Election Form [PDF] Eligible new hires must be complete and submit within 120 calendar days of start date. Upload completed form to the Benefits secure upload site .
    Visit Retirement Options at Ohio University for New Hires to learn more. 
    Retirement Separation [PDF] 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.
    Salary Reduction Agreement [Excel] Complete this form when starting, stopping or making a change to your Supplemental Retirement Accounts (SRA), 403b or 457. Requires physical signature. Upload completed form to the Benefits secure upload site .
    Sick Leave Conversion [PDF] 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.
    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.
    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.
    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.
    Vision Out of Network Reimbursement, VSP [PDF] Use to request reimbursement for out of network vision costs.
    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.
    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
    Workers Compensation, Employee Work Related Incident Form [PDF] To be completed by supervisor and employee immediately after a work-related injury, illness or incident.
    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.
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