Human Resource Forms
- Dental Care
- Health Care
- Life Insurance
- New Hire Forms
- Non-Employee Forms
- Retiree or Former Faculty/Staff/GA Personal Data Change Form
- Vision Plan
Retiree Enrollment Form - Over 65 (pdf)
Retiree Enrollment Form - Under 65 (pdf)
Waiver Forms/Retiree Enrollment:
Retiree Enrollment Form - Over 65 (pdf)
Retiree Enrollment Form - Under 65 (pdf)
Claim Forms:
Anthem Medical Claim (pdf)
Medical Claim Form for Claims Incurred Internationally (pdf)
The Hartford Beneficiary Designation Form (pdf)
Benefits:
Social Security Number Exception Request Form (pdf)
TIAA New Hire Flyer (pdf)
Background Check Verification Process (Adobe web form)
Direct Deposit (Employee Self Service instructions) Note: Employee Self Service will be accessible once you are notified by UDit that your UD account has been created.)
Employee Data Sheet Packet - Staff (Adobe web form)
Employee Data Sheet Packet - Faculty (Adobe web form)
Federal Withholding Instructions (W-4) (pdf)
Online Form I-9: Section 1 (The I-9 contains two separate sections referred to as Section 1 and Section 2. The cover page for Section 1 provides critical instructions - please review this page carefully. Please contact us at HR@udayton.edu with any questions).
State of Ohio Withholding Certificate (IT4) (Adobe web form) - Employees working outside of Ohio, visit your state's revenue site to download and complete the appropriate State Withholding form.
* In addition to the above forms, Research Institute employees must also complete the following:
UDRI New Hire Forms (Adobe web form)
Conflict of Interest Disclosure Form (pdf) Return completed form to supervisor
Visiting Scholar Application (tdx)
UDRI Visitor Technology Access Request (VTAR) (doc)
RETIREE or FORMER FACULTY/STAFF/GA PERSONAL DATA CHANGE
Retiree or Former Faculty/Staff/GA Change in Personal Data (Adobe web form)
EyeMed Out-of-Network Claim Form (pdf)
EyeMed Provider Nomination Form (pdf)