Forms

Benefits Forms

Eyeglass Reimbursement Form
Tuition Benefit Application Forms: Faculty & Administrative Staff; Service, Security and Clerical Staff
Guardian Dental Claim Form
Excellus BlueCross BlueShield Claim Form

Lifetime Benefit Solutions (formerly EBS-RMSCO) Reimbursement Request Form
Lifetime Benefit Solutions (formerly EBS-RMSCO) Dependent Reimbursement Form
Lifetime Benefit Solutions (formerly EBS-RMSCO) Certification of Medical Necessity
Lifetime Benefit Solutions (formerly EBS-RMSCO) Direct Deposit Authorization Form
CanaRx Formulary
CanaRx Enrollment Form
Transitioning to Express Scripts 

Faculty Parental Leave Program Request Form

Faculty Request for Maternity Leave Form

Payroll Forms

Change of Address Form
Check Distribution - Direct Deposit Form
Employment Requisition - Regular Hire (Non-exempt/hourly)
Employment Requisition - Temporary Hire (Non-exempt/hourly)

Personnel Status Change Form

New Employee Forms

Employment Requisition - Temporary Hire (Non-exempt/hourly)
Information Change Form
New Employee Progress Report - CSEA
New Employee Progress Report - SEIU (Dining Services)
New Employee Progress Report - SEIU (Facilities Operations)

Miscellaneous Forms

Incident Report Form
Desk Audit Request Form
Desk Audit Process

Faculty Request for Maternity Leave Form (Tenured and Tenure-Track Faculty Women Only)
Leave of Absence Request Form
Parental Leave Request Form
Employee Separation Checklist

Performance Evaluation Form Samples

Employee Evaluation - Facilities Operations
Sample Performance Evaluation Form
Non-Exempt Performance Evaluation Form
Employee Performance Report - SEIU

Performance Evaluation Form (.pdf and Word versions available; used for exempt positions)