The Forms Library can also be accessed through the FlashLine portal, by clicking on the My HR tab.
Forms Library
The Forms Library can also be accessed through the FlashLine portal, by clicking on the My HR tab.
Forms Library
| Absence from Work (Leave) Forms and Information |
Leave Donation
Leave Request Forms
- Leave Request
- Leave Request (AFSCME)
- Certification of Healthcare Provider Form
- Poll Worker Verification Form
Banner HR Leave Information
- Leave Request Feature Added to Banner HR
- Banner Leave Request/Leave Report Flowchart
- Banner Leave Request/Leave Report Examples
Family Medical Leave Act Information
| Benefit Forms and Information |
Benefits Summary (Benefits in Brief)
Customer Service Contact Information
Dental
- Aetna Dental Claim Form
- Aetna DMO Plan Summary
- Medical Mutual SuperDental Plan Summary
- Aetna DMO Co-Payment Schedule
Flexible Spending Accounts
- Flexible Spending Account Enrollment Form
- Health Care/Dependent Care Flexible Spending Account Bulletin
- DCFSA Claim Reimbursement Form
- HCFSA/HRA Claim Reimbursement Form
Life Insurance
- Booklet for Standard Life Insurance
- Supplemental Life Insurance Enrollment/Beneficiary Change Form
- Beneficiary Change Form
- Medical History Form
Medical
- Dependent Verification
- Anthem Plan Booklet
- Anthem Claim Form
Group Insurance Enrollment Form - Part-Time - Group Insurance Enrollment Form - Full-Time
- Medical Mutual & Anthem Campus Service Visit Schedule
- Medical Mutual Medical Claim Form
- Medical Mutual Medical Plan Booklet
- Medical Plans Comparison Chart
- Opt-Out Affidavit
- Medical Contributions - Full-Time
- Medical Contributions - Part-Time
Prescription
- Caremark Mail Order Prescription Form
- Caremark Primary Drug List
- Caremark Prescription Claim Form
- Caremark Prescription Plan Booklet
- Medicare Part D Disclosure Notice
Retirement Programs
- 403(b) Tax Deferred Annuity Provider List
- 457 Deferred Compensation Provider List
- Alternative Retirement Plan (ARP) Provider List
- Declaration of Prior State Service
- OPERS Personal History Record
- OPERS Retirement Plan Election Form (Full-Time Classified & Unclassified)
- Salary Reduction Agreement for Tax Deferred Annuity and/or Deferred Compensation
Social Security Windfall Notification - Statement Concerning Your Employment in a Job Not Covered by Social Security
- STRS Retirement Plan Election Form (Full-Time Faculty)
Tuition
Current University employees must apply for tuition benefits by utilizing the Tuition Waiver Benefit Request workflow, which is available on the My Action Items tab on FlashLine.
- Tuition Benefit Request for ROTC Staff, Retirees & Disabled Employees
- Tuition Benefit Request for Dependents of ROTC Staff, Retirees & Disabled Employees
Vision
Voluntary Group Long-Term Disability
| Employee Recognition Forms and Information |
The Distinguished Staff Recognition Program has been suspended to allow time for the division of Human Resources to restructure the employee recognition program. Please go to the Distingushed Staff Recognition page for information.
- Outstanding University Citizen Award Nomination Form (disabled)
- Quality Service (Individual) Award Nomination Form (disabled)
- Quality Service Team Award Nomination Form (disabled)
- University Leadership Award Nomination Form (disabled)
- Cross-Divisional Team Award Nomination Form 9disabled)
| Employment Forms and Information |