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E-FAX NUMBERS
HR Data Management | 480.993.0005
HR Background Checks | 480.993.0006
HR Benefits & Leaves | 480.993.0007
HR Retirement | 480.993.0008
A-C | D-H | I-O | P | R | S | T-U | V-Z
Background/Fingerprinting | Benefits | Claim Forms | Leaves Management | Retirement | Tuition Waivers
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Form Name |
Purpose/Description |
Format |
A-C |
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A-4
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A-4 Instructions. (An electronic A-4 is available through My ASU > Employee Info > My Employment > Payroll Tab > Tax Information > A‐4 Tax Information.) | PDF & Instructions |
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Academic Bi-Weekly Pay Calendar
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Bi-Weekly Pay Calendar for Academics | HR Web page |
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Applicant List- for resumes
sent directly to departments |
Use this form to track resumes received from applicants replying to a posted position. | |
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ASU ID Number Change Request
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Employees Only - Use this form to request a change to an ASU ID number that is not a Social Security Number. | Word |
BACKGROUND/FINGERPRINTING |
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BACKGROUND VERIFICATION |
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| Background Check Request (includes Consent and Disclosure Form) |
Use these forms to perform a background verification for a new employee. Visit the HR web page for more info. |
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| Pre-Employment Inquiry Form | ||
| Driver's License Authorization | ||
| Request for Security or Safety Sensitive Position | ||
FINGERPRINTING |
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| Pre-Adverse Action Notice | Use these forms to perform a background verification for a new employee. Visit the HR web page for more info. | DOC |
| Adverse Action Notice | DOC | |
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BENEFITS PROGRAM |
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COBRA
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Administered by the Arizona Dept. of Administration, Benefits Services Div. |
ADOA COBRA Info & Forms |
| Benefits Enrollment/Change Form | ||
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Benefits Enrollment Process |
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IMPORTANT: See Retirement Info below. |
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FLEXIBLE SPENDING ACCOUNTS |
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| Claim Form (State of Arizona Employee forms are the 2nd listing on the page; you can choose either an interactive PDF or a word document) |
External Page | |
| Direct Deposit/Email Notification | External PDF | |
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Healthcare FSA Benny Card Application |
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Dependent/Beneficiary
Personal Data Update Form |
Use this form to request a change of incorrect information for a dependent and/or beneficiary. | |
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Dissolution of Domestic Partnership
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Use tthis form to report the termination of your domestic partnership. | |
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Long-term Disability Health Insurance
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Enrollment form for employees approved for long-term disability benefits by the insurance carrier | |
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Name Change (ASU)
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Form for employees to use to request a name change
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Name Change/Change of Address (ASRS)
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Form for employees who are ASRS members to request a name and/or address change. NOTE: Submit the completed form to ASRS, not ASU. |
ASRS Personal Information Forms |
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Prescription Mail Order
|
Use to get a 90-day prescription from Walgreens Health Initiatives by mail. | |
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Prescription
Mail Order Fax (For Physicians) |
Physician should use to order a 90-day prescription from Walgreens Health Initiatives. | External PDF |
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Prescription Reimbursement
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Use to request a reimbursement from MedImpact when you have paid out-of-pocket for a prescription. | |
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Transition of Care
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Use this form to request continuation of medical care with a provider who is not in your chosen network. | |
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Tuition Waivers
|
See Tuition Waiver Options below | |
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Workers' Compensation
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See Workers' Compensation section below. | |
CLAIM FORMS |
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Dental Claim
|
Use to submit a claim to Delta Dental. | |
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Medical Claim Forms
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Forms used to claim medical expenses: United Healthcare |
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Vision Plan Out-of-Network Claim
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Use to claim out-of-network vision benefits. | External PDF |
D-H |
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Data Management Exception
|
Use this form for PeopleSoft actions that cannot be entered via PeopleSoft Manager Self-service by the required deadline(s), or because of limitation of program options or hard system errors. | |
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Data Management EFax Cover Sheet
|
Use when you are efaxing documents to Data Management | |
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Department Code Change Request Form
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Departments should use this form to request new department codes or modifications to existing codes. Fill out at least two weeks before the effective date of the change. | Online Form |
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Direct Deposit
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Form used to establish or change direct deposit of pay. | ASU Interactive |
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Dissolution of Domestic Partnership
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Use tthis form to report the termination of your domestic partnership. | |
| This form, used to fill an open position that needs an immediate hire, has been replace by the Waiver of Recruitment form. | ||
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Download and fill out these forms (.pdfs) before your first appointment with EAO | ASU Employee |
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Equal Employment Opportunity Survey
|
Voluntary survey for applicants who apply for faculty and other academic positions | Online |
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Exit Interview Questionnaire
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Optional questionnaire for employees leaving ASU | Word or Online version |
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Faculty and Academic Professional Search Plan
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Use when beginning a search for a faculty member or academic professional | |
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FICA Refund Request
|
Use this form when an employee requests a prior year refund on FICA OASDI and MEDICARE. | PDF or Word |
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Flexible Employment
Conversion Application |
Use this form to volunteer to reduce your time worked by one to six pay periods a year. | Word |
| This form has been replaced by the Waiver of Recruitment |
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| Form to comply with regulations regarding the taxation and reporting of payments made to individuals who are not residents for tax purposes. | PDF or Word | |
| Paper forms are no longer accepted. Please use eHire (accessed through My ASU). | Access eHire through My ASU |
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I-O |
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I -9
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Form for Employment Eligibility Verification | External PDF |
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Independent Contractor Checklist
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Use this form for review and approval of Independent Contractors before performance of services begins. | PDF Word Glossary |
LEAVES MANAGEMENT |
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FOR EMPLOYEES |
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| Authorization for Release of Health Care Information |
One of several forms you need to submit to request an FMLA medical leave | Leaves Management Online |
| Compassionate Transfer of Leave | Request for donated hours | |
| Authorization to donate hours | ||
| Employee Acknowledgement | One of several forms you need to submit to request a leave for birth/placement/bonding | Leaves Management Online |
| Leave of Absence Request | Request leave for birth/placement/bonding or medical or personal reasons |
Leaves Management Online |
| Leave of Absence Request - Employee Military Leave |
Request leave for military training/active duty | Leaves Management Online |
| Release to Return to Work | Health care provider certification | Leaves Management Online |
| Request for Time Off | Hourly employee sick/vacation/ compensatory/bereavement/jury request |
Word Doc |
FOR DEPARTMENTS
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| Birth/Placement/Bonding: FMLA | Notice of Eligibility, HC Provider Certification, Designation Notice | Guide |
| Birth/Placement/Bonding: Non-FMLA | Conditional Approval, Medical Documentation, Designation Notice | Guide |
| Compassionate Transfer of Leave Supervisor's Memo |
Initiate CTL process with OHR | |
| Determining FMLA Eligibility | The three steps used to establish eligibility for FMLA leave | Guide |
| Employee Health: FMLA | Notice of Eligibility, HC Provider Certification, Designation Notice | Guide |
| Employee Health: Non-FMLA | Conditional Approval, Medical Documentation, Designation Notice | Guide |
| Employee Military: Non-FMLA | Designation Notice | Guide |
| Employee Personal: Non-FMLA | Designation Notice | Guide |
| Familiy Member Health: FMLA | Notice of Eligibility, HC Provider Certification, Designation Notice | Guide |
| Family Member Health: Non-FMLA | Conditional Approval, Medical Documentation, Designation Notice | Guide |
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Leave of Absence or Hold: Business Reasons |
Place employee on sabbatical, administrative leave or hold | |
| Leave of Absence Status Change | Change type, date, pay or employee status of a leave | |
| Military Family Business: FMLA | Notice of Eligibility, Certification, Designation Notice | Guide |
| Military Family Health: FMLA | Notice of Eligibility, HC Provider Certification, Designation Notice | Guide |
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Name Change (ASU)
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Form for employees to use to request a name change
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Name Change/Change of Address (ASRS)
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Form for employees who are ASRS members to request a name and/or address change. NOTE: Submit the completed form to ASRS, not ASU. |
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New Employee Payroll Packet
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Payroll and other HR forms needed from new hires. | |
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Non-Exempt Employee Calendar
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Alternate record for reporting time worked. Click on the tabs at the bottom of the spreadsheet for the pay period in which you are recording time worked. | HRIS web page |
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Owner Automobile Mileage Report
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Report of miles driven for dealer owned automobiles. | Word |
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OUT-OF-STATE EMPLOYEE |
Approval of Out-of-state Employee (New Hire or Relocation) | |
P |
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Pay Option: |
Form used to select payment options for faculty on academic year appointments. | |
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Payroll Packet
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SEE NEW EMPLOYEE PACKET | |
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Payroll Redistribution
and Instructions |
Request a payroll expense transfer. | |
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Performance Management Forms
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Performance Evaluation--Management |
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Personal Data Change
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Form used for existing employees to report changes of personal information. | ASU Interactive |
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Personnel File Request Form
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ASU employees outside of the Office of Human Resources should use this form to request access to view an employee's personnel file |
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Post Offer of Employment
Physical Exam Sheet |
Use this form when requiring an employee to have a physical examination. | PDF or Word |
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Pre-Employment Inquiry Form
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To be filled out by job candidates before a background check or fingerprinting is done | |
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R |
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Recruitment Handbook
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Use for guidance in recruiting faculty and academic professsionals | |
RETIREMENT PROGRAM |
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GENERAL |
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ADOA Retiree Health Insurance
Enrollment Form |
Administered by the Arizona Dept. of Administration (ADOA), Business Services Division | |
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Declaration of Understanding/
Election of Retirement Plan |
Acknowledgement of 30-day election period. | |
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Election of Retirement Option Form
|
Use to elect retirement option | |
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Retirement Certificate Request
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Form to request certificate to honor ASU employees who retire with five or more years of continuous service |
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Vacation/Compensatory Time
Termination Worksheet |
Form used to calculate Vacation/Compensatory time for terminating employees. | |
ARIZONA STATE RETIREMENT SYSTEM (ASRS) |
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Affidavit of Public Service
with ASRS Employer |
Use for Public Service Purchase | |
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Affidavit of Military Service
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Use for Military Service Purchase | |
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Arizona State Retirement System (ASRS)
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Enrollment/Registration Instructions | Online |
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ASRS Notification of Current Membership
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Use this form to verify your current ASRS membership when you join ASU (so the 182-day waiting period can be waived) | |
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ASRS Reimbursement of Medical and Dental Cost Instructions/Forms
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This form is used for eligible retirees and LTD participants who have insurance coverage, either as a policyholder or as a dependent, under an employer's active employee group plan. | |
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ASRS Retiree Return to Work
for an ASRS Employer |
Form to use when an ASRS retiree is returning to work for an ASRS employer | |
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Ending Payroll Verification Form
for Retiring Members |
Form to be completed when employee is retiring from ASRS | |
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Name Change (ASU)
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Form for employees to use to request a name change INSTRUCTIONS |
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Name Change
|
Form employees who are ASRS members should use to request a name and/or address change. NOTE: Submit the completed form to ASRS, not ASU |
ASRS Personal Information Forms |
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Withdrawal of Contributions and Termination
of Membership Form |
Form to be completed when an employee has left the University and wants to withdraw their contributions Online info about the process |
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PUBLIC SAFETY PERSONNEL RETIREMENT SYSTEM (PSPRS) |
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Change of Beneficiary Designation Form
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Form to be completed when designating a new beneficiary for PSPRS | |
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Lump Sum Distribution Election Form for Refunds
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Use for refunds from PSPRS | |
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Membership Form
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For new PSPRS Members | |
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Name or Address Change Form
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Use to change name or address with PSPRS | |
RETIREE ACCUMULATED SICK LEAVE PROGRAM (RASL) |
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Retiree Accumulated Sick Leave Program (RASL)
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Application and Instructions Checklist Federal W-4 State A-4 |
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S |
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Sample Letters |
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Sample Offer Letter
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Use these sample templates to confirm Classified or Service Professional employment offers. | HR Advisor Sample Letters and Checklist |
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Sample Regret Letter (Budget)
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Use this form as a template to notify applicants that the position will not be filled at this time. | HR Advisor Sample Letters and Checklist |
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Sample Non-select Letter (Applicant)
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Use this form as a template to notify applicants that they were not selected. | HR Advisor Sample Letters and Checklist |
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Sample Non-select Letter (Interviewee)
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Use this form to notify applicants that have been interviewed, that they were not selected. | HR Advisor Sample Letters and Checklist |
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Savings Bonds
|
Authorize a deduction from your pay to purchase U. S. Savings Bonds; or to change beneficiary. | HR Advisor Sample Letters and Checklist |
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Summer Address
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Use this form to provide HR with your summer address information. | Word |
T-U |
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Temporary Employment Request (External)
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Use this form when completing a Temporary Employment Request with an external temporary agency. |
Word |
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Temporary Employment Request (Internal)
|
Use this form when completing a Temporary Employment Request with Staffing Services. |
Word |
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Timesheet
|
For non-exempt employees to manually record work time | Word |
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Timesheet Enhancement
Documentation |
Technical info about enhancements made to the online timesheet for |
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TUITION WAIVER PROGRAM |
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Tuition Waiver (1)
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Classes at any ASU campus: • Employee • Employee's spouse • Employee's dependent(s) |
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Tuition Waiver (2)
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Classes at UA or NAU: • Employee, • Employee spouse • Employee dependent(s) Classes at ASU, UA or NAU: |
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Tuition Waiver
for ASU Domestic Partners and Dependents |
Tuition waiver form for domestic partners and their dependents |
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V-Z |
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Vacation/Compensatory Time
Termination Worksheet |
Form used to calculate Vacation/Compensatory time for terminating employees. | |
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Verification of Employment
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Use this form to request a verification of employment. | |
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W-2 Request
|
Use this form to request a duplicate copy of a W-2 or 1042S | |
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W-4
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Employee's Federal Income Tax Withholding Allowance Certificate | |
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Waiver of Right to
Pre-termination Hearing |
Form to be used if you have been notified to attend a pre-termination hearing and you will not attend. | |
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Waiver of Recruitment
|
This form replaces the Focused Recruitment Form. | |
| Flow Chart Employer's Report of Injury Supervisor's Incident Report Authorization for Payment Release To Return to Work |
PDF External PDF |
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