HR forms

E-fax numbers:

Employment data management - 480-237-9011
Background checks - 480-993-0006
Benefits and leaves - 480-993-0007
Retirement - 480-993-0008

If you need forms for academic personnel, visit this page.

A-C

Name	Purpose - description
A-4	A-4 Instructions. An electronic A-4 is available through My ASU > Employee Info > My Employment > Payroll Tab > Tax Information > A‐4 Tax Information.
Applicant List- for resumes sent directly to departments	Use to track resumes received from applicants replying to a posted position.
ASU ID number change request	Employees Only - Use to request a change to an ASU ID number that is not a social security number.
Background checks
Verification	Use to perform a background verification for a new employee. Visit the background and fingerprints webpage for details. Background check request. Driving for ASU. Request for security or safety-sensitive position.
Fingerprinting	Use the authorization for a fingerprint clearance card form to perform background verification for a new employee. Visit the background and fingerprints webpage for details.
Benefits program
Benefits enrollment	2024 benefits enrollment and change form. 2025 benefits enrollment and change form. Benefits enrollment checklist. Dependent and beneficiary revision. HSA payroll deduction authorization. Supporting documentation. Important: See the retirement section below.
COBRA	Administered by the Arizona Department of Administration, Benefits Services Division.
Family adoption and fertility benefits	Adoption benefits subsidy request form. Fertility benefits subsidy request form.
Flexible Spending Accounts	Claim form - Use the General FSA Claim Form. Direct deposit and email and text notification - Sign up for a direct deposit and get email or text notices of account activity.
Prescription mail order	MedImpact mail service registration and prescription order form for the state of Arizona and university employees.
Prescription reimbursement	Visit our pharmacy plan webpage for details about requesting a reimbursement from MedImpact when you have paid out-of-pocket for a prescription.
Unum beneficiary designation	For Unum short-term disability participants to designate a beneficiary for the Unum Life or AD&D insurance policy.
Claim forms
Dental claim	Use to submit a claim to Delta Dental.
Medical Claim	Blue Cross Blue Shield of AZ. United Healthcare.
Vision plan out-of-network claim	Used to claim out-of-network vision benefits.

D-H

Name	Purpose - Description
Data management	Data Management Exception: Used for PeopleSoft actions that cannot be entered via Personnel Transaction Request by the required deadline or because of limitation of program options or hard system errors.
Department code change request	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.
Direct deposit	Used to establish or change direct deposit of pay.
Disability self-identification	Employee use to voluntarily self-identify as having a disability.
Employee Assistance Office	Visit Counseling and Wellness to complete an EA intake form for new clients.
Equal Employment Opportunity survey	Voluntary survey for applicants who apply for faculty and other academic positions.
Exit interview questionnaire	Optional questionnaire for employees leaving ASU.
FICA refund request	Use this form when an employee requests a prior-year refund on FICA OASDI and MEDICARE.
Flexible employment conversion application	Use this form to volunteer to reduce your time worked by one to six pay periods a year.
Focused recruitment	This form has been replaced by the Waiver of Recruitment.
Hiring process report	Paper forms are no longer accepted. Please use eHire which can be accessed through My ASU.

I-O

Name	Purpose - Description
I -9	Form I-9 for in-person verification of employment eligibility. New employees outside of Arizona must follow these remote Form I-9 instructions to complete form.
Independent contractor checklist	Use this form for review and approval of Independent Contractors before the performance of services begins.
Information for exiting-employees	Overview of information for employees leaving ASU.
Leaves of absence for employees
Authorization for release of health care information	One of several forms you need to submit to request an FMLA medical leave.
Compassionate transfer of leave	Compassionate transfer of leave request form. Request for donated hours.
Employee acknowledgment	One of several forms you need to submit to request a leave for birth, placement or bonding.
Leave of absence request	Employee Military Leave - Request leave for military training or active duty. Request leave for birth, placement or bonding or medical or personal reasons.
Release to return to work	Health care provider certification.
Request for time off	Hourly employee sick, vacation, compensatory, bereavement or jury request.
Leaves management for departments
FMLA tracking spreadsheet	Record approved FMLA time for intermittent and continuous leaves of absence.
Leave of absence or hold	Business reasons - Place employee on sabbatical, administrative leave or hold. Business reasons: designation notice - Notice that a leave of absence has been approved. Status change - Change type, date, pay, or employment status of a leave.
Name change - ASU	Review our policy about requesting a name change. Complete the application for a name change. Schedule an in-person appointment to submit the application with documentation.
Name change and change of address	For employees who are ASRS members to request a name and address change. Note: Submit the completed form to ASRS, not ASU.
New hire packet Domestic hire. International hire.	HR forms and payroll information.
Non-exempt employee calendar	An 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.
Out-of-state employee	Approval for out-of-state employee new hire or relocation form.

P-R

Name	Purpose - Description
Pay option agreement	The form used by faculty and academic professionals on academic year appointments to change their pay schedule.
Payroll action request	A course on how to correct an employee's pay.
Personal data change	Report changes to personal information for current ASU employees. Use the My Profile tab.
Personnel file request	ASU employees should use this form to request access to view an employee's personnel file.
Pre-employment inquiry	To be filled out by job candidates before a background check or fingerprinting is done.
Retirement program
General
ADOA retiree health insurance enrollment	Administered by the Arizona Department of Administration, Benefit Services Division.
Election of retirement option	Use to elect retirement option.
Arizona State Retirement System
Affidavit of public service with ASRS employer	Use for Public Service Purchase.
Affidavit of military service	Use for Military Service Purchase.
Age 65 and older membership waiver	This waiver form must be filed with ASRS within 30 days of employment.
Arizona State Retirement System	Enrollment and registration instructions.
ASRS reimbursement of medical and dental cost instructions forms	This form is used by eligible retirees and LTD participants to request reimbursement of premiums, if they have insurance coverage, either as a policyholder or a dependent, under an employer’s active group plan.
ASRS retiree return to work for an ASRS employer	ASRS retirees must complete the online form to report the terms of their employment with an ASRS employer.
Name change	ASRS - For ASRS members who need to change their name or address in the ASRS records and systems. ASU - Form for employees to use to request a name change.
Withdrawal of contributions and termination of membership	Form to be completed when an employee has left the University and wants to withdraw their contributions.
Public Safety Personnel Retirement System
Change of beneficiary designation	Form to be completed when designating a new beneficiary for PSPRS.
Lump-sum distribution election for refunds	Use for refunds from PSPRS.
Membership	For new PSPRS Members.
Name or address change	Use to change name or address with PSPRS.
Retiree Accumulated Sick Leave program
Retiree Accumulated Sick Leave Program	Note: The original RASL application and instructions, checklist, Federal W-4 and Arizona A-4 forms are required and must be submitted to OHR Benefits within 150 days of retiring. The Deferral Notification form is optional and is submitted to Nationwide Retirement Solutions as instructed on this form. Application and instructions, checklist and deferral notification - optional. Arizona A-4. Federal W-4.

S-U

Name	Purpose - Description
Tuition reduction program Forms are submitted online. Visit the qualified tuition reduction program webpage for additional details about the program.
Sample offer letters	Offer letters are automated for staff and student hires through Kenexa BrassRing. Visit the HR toolkit to view types of offer letters and communications. These letters are used to confirm classified or service professional employment offers, notify applicants that they were not selected or notify interviewed applicants they were not selected. Final recruitment is closed through PeopleSoft TAM.
Tuition reduction \| ASU	Classes at any ASU campus for an employee, employee's spouse, employee's dependents.
International Employees - living outside the USA	Classes at any ASU campus for an employee, employee's spouse, employee's dependents.
Tuition reduction \| ASU, NAU, UA	Classes at UA or NAU for an employee, employee's spouse, employee dependents. Classes at ASU, Northern Arizona University, University of Arizona: Eligible LTD participants, their spouses and dependents. Retiree, their spouse and dependents.
Tuition reduction \| ASU affiliates	For classes at ASU, Northern Arizona University and the University of Arizona.

V-Z

Name	Purpose - Description
Veteran self-identification	This Protected Veteran Post-offer Invitation to Self-identify form is for military veterans only in four specific categories.
W-2 request	Use this form to request a duplicate copy of a W-2 or 1042S.
W-4	Employee's Federal Income Tax Withholding Allowance Certificate.
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.
Workers' Compensation	Packet includes instructions and forms that must be completed to file a workers' compensation claim.