HR Forms
Adoption Reimbursement
Banner Forms
Bombeck Family Learning Center Discount
Continuing Education
Dental Care
Emergency Loan Application
Flexible Spending
Health Care
Leave/Sabbatical Forms
Life Insurance
Long Term Care
Long Term Disability
New Hire Forms
Non-Employee Forms
Outside Employment & Additional Services
Payroll Forms
Performance Appraisal Forms
Personal Data Change Form
Personnel Action Form (PAF)
Position Classification Justification Forms
Retirement Forms
Separation Forms
Tax Forms
Tuition Exchange
Tuition Remission
Vision Plan
Wellness Forms
Worker's Compensation Claim Forms
Adoption Reimbursement Form (doc)
Paper Leave Report for Exempt Employees (xls)
Paper Time Sheet for Benefit Eligible Nonexempt Employees (xls)
Paper Time Sheet for Part Time Nonbenefit Eligible Employees and Student Employees (xls)
Unpaid Personal Leave Form for Exempt Employees (doc)
BOMBECK FAMILY LEARNING CENTER
Bombeck Family Learning Center Discount Form (pdf)
Continuing Education Funds - General Form (pdf)
Continuing Education Funds - CLED Executive Program (pdf)
Continuing Education Funds - CLED Emerging Leader Program (pdf)
Superior Dental Enrollment Form (pdf)
Dental Waiver Form (pdf)
Emergency Loan Application (pdf)
Enrollment Form (pdf)
Change Form (pdf)
Direct Deposit Enrollment Form (pdf)
Medical & Dependent Care Claim Form (pdf)
Orthodontic Claim Form (pdf)
Enrollment Forms
Indicate your plan choice by writing "Core" or "Advantage" in section 4 on the Anthem enrollment form titled "Type of Coverage/Plan."
Affidavit of Dependency for Federal Group Coverage (doc)
Anthem Healthcare Enrollment/Change Form (pdf)
Pretax Treatment of Health & Dental Premiums (doc)
Claim Forms
Anthem Medical Claim (pdf)
Medical Claim Form for Claims Incurred Internationally (pdf)
Prescription Forms
Express Scripts Mail Order Form (PDF) - for Active Employees, GA's, and Under 65 Retirees 1-866-216-5449
Express Scripts Mail Order Form (PDF) - for Medicare Eligible Retirees
Waiver Forms
Employee Health Care Waiver Form (pdf)
Graduate Assistant Health Care Waiver Form (pdf)
Retiree Health Care Waiver Form (pdf)
LEAVE/SABBATICAL FORMS
FMLA/Leave/Sabbatical Form (doc)
Military Leave Form (pdf)
Unum Life Insurance Form (pdf)
Unum Evidence of Insurability Form (pdf)
Unum Beneficiary Designation Form (pdf)
Unum Accidental Death & Dismemberment Form (pdf)
Waiver of Entitlement to Group Term Life Insurance (in Excess of $50,000) (doc)
Long Term Care Short Enrollment Form (pdf)
Long Term Care Long Enrollment Form (pdf)
Unum Long Term Disability Form (pdf)
Unum Evidence of Insurability Form (pdf)
Background Check Release (pdf)
Direct Deposit Form (doc)
Employee Data Sheet - Staff (doc)
Employee Data Sheet - Faculty (doc)
Employment Eligibility Verification (I-9) (pdf)
Federal Withholding Certificate (W-4) (pdf)
State of Ohio Withholding Certificate (IT4) (pdf)
In addition to the above forms, Research Institute employees must also complete the following:
New Hire Forms Checklist & Instructions (pdf)
Office of Federal Procurement Policy Act (pdf)
Computer Usage Policy (pdf)
Intellectual Property Rights Agreement (pdf)
Conflict of Interest Policy (pdf)
Conflict of Interest Disclosure Form (pdf)
Determination and Resolution Form (pdf)
Procedure for Implementing UDRI's Business Ethics & Integrity Code (pdf)
Business Ethics & Integrity Code Addendum (pdf)
Employment Agreement (pdf)
Non-Employee Agreement (pdf)
Non-Employee Information Sheet (pdf)
Background Check Release form (pdf)
Visitor Personal Action Form (PAF) (xls)
OUTSIDE EMPLOYMENT & ADDITIONAL SERVICES
Outside Employment & Additional Services Approval Form (pdf)
Direct Deposit Form (doc)
Paper Leave Report for Exempt Employees (xls)
Paper Time Sheet for Benefit Eligible Nonexempt Employees (xls)
Paper Time Sheet for Part Time Nonbenefit Eligible Employees and Student Employees (xls)
Unpaid Personal Leave Form for Exempt Employees (doc)
General Competency Option (doc)
Goals Based Option- Version 1 (doc)
Goals Based Option- Version 2 (doc)
Mission Based Competency Option (doc)
Narrative Option (doc)
Request for Change of Personal Data Form (doc)
Personnel Action Form (PAF) (xls)
POSITION CLASSIFICATION JUSTIFICATION
Position Classification Justification Form (doc)
Position Description Guidelines (pdf)
RETIREMENT
Salary Reduction Agreement (pdf)
Fidelity Investments 403(b) Beneficiary Designation Form (pdf)
TIAA CREF Beneficiary Designation Form (pdf)
Employee Separation Checklist (doc)
Exit Interview Questionnaire (doc)
Federal Withholding Certificate (W-4) (pdf)
State of Ohio Withholding Certificate (IT-4) (pdf)
Tuition Exchange Application (doc)
Tuition Remission Application for Employee (doc)
Tuition Remission Application for Child or Spouse (doc)
VISION PLAN
EyeMed Out-of-Network Claim Form (pdf)
EyeMed Provider Nomination Form (pdf)
Weight Watchers Agreement & Application (pdf)
WORKERS COMPENSATION
Workers Compensation Claim Form (pdf)