hr forms
Find the HR Form You Need
E-FAX NUMBERS
HR Employment Data Management | 480.237.9011
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
FORM NAME |
PURPOSE/DESCRIPTION |
FORMAT |
A-C |
||
|
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.) | |
|
Academic Bi-Weekly Pay Calendar
|
Bi-Weekly Pay Calendar for Academics | HR Web page |
|
Applicant List- for resumes
sent directly to departments updated 5.1.13 |
Use this form to track resumes received from applicants replying to a posted position. | |
|
ASU ID Number Change Request
|
Employees Only - Use this form to request a change to an ASU ID number that is not a Social Security Number. | Word |
BACKGROUND/FINGERPRINTING |
||
BACKGROUND VERIFICATION |
||
| 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. |
|
| Pre-Employment Inquiry Form | ||
| Driver's License Authorization | ||
| Request for Security or Safety Sensitive Position | ||
FINGERPRINTING |
||
| 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 | |
| Authorization Form for Fingerprint Clearance Card | ||
| return to top | ||
BENEFITS PROGRAM
|
||
|
|
|
|
|
Benefits Enrollment Process |
||
|
IMPORTANT: See Retirement Info below. |
||
|
FLEXIBLE SPENDING ACCOUNTS |
||
| Claim Form University employees must use the Arizona Board of Regents FSA Claim Form (3rd form on the page, available in both PDF and Word versions) |
External Page | |
| Direct Deposit/Email Notification | External PDF | |
|
Healthcare FSA Benny Card Application |
||
|
COBRA
|
Administered by the Arizona Dept. of Administration, Benefits Services Div. | ADOA COBRA Info & Forms |
|
Dependent Data Update Form
|
Use this form to request a change of incorrect information for a dependent and/or beneficiary. | |
|
Dissolution of Domestic Partnership
|
Use this form to report the termination of your domestic partnership. | |
|
Long-term Disability
|
ADOA health insurance enrollment form for employees approved by the insurance carrier to receive LTD benefits | |
|
Name Change (ASU)
|
Form for employees to use to request a name change
|
|
|
Name Change/Change of Address (ASRS)
|
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 |
|
Prescription Mail Order
|
Walgreens Mail Service Registration and Prescription Order form (for State of Arizona, including universities) | |
|
Prescription
Mail Order Fax (For Physicians) |
Physician should use to order a 90-day prescription from Walgreens Mail Service. |
External PDF |
|
Prescription Reimbursement
|
Use to request a reimbursement from MedImpact when you have paid out-of-pocket for a prescription. | |
|
Transition of Care
|
Use this form to request continuation of medical care with a provider who is not in your chosen network. | |
|
Tuition Waivers
|
See Tuition Waiver Options below | |
|
Workers' Compensation
|
See Workers' Compensation section below. | |
CLAIM FORMS |
||
|
Dental Claim
|
Use to submit a claim to Delta Dental. | |
|
Medical Claim Forms
|
Forms used to claim medical expenses: United Healthcare |
|
|
Vision Plan Out-of-Network Claim
|
Use to claim out-of-network vision benefits. | |
D-H |
||
|
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. | |
|
Data Management EFax Cover Sheet
|
Use when you are efaxing documents to Data Management | |
|
Department Code Change Request Form
|
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 |
|
Direct Deposit
|
Form used to establish or change direct deposit of pay. | ASU Interactive |
|
Dissolution of Domestic Partnership
|
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. | ||
|
|
Download and fill out these forms (.pdfs) before your first appointment with EAO | ASU Employee |
|
Employee Referral Program Form
(for ASU Police Department referrals only) |
Use this form to refer applicants for the positions of Police Officer Recruit or Police Officer | |
|
Equal Employment Opportunity Survey
|
Voluntary survey for applicants who apply for faculty and other academic positions | Online |
|
Exit Interview Questionnaire
|
Optional questionnaire for employees leaving ASU | Word or Online version |
|
Faculty and Academic Professional Search Plan
|
Use when beginning a search for a faculty member or academic professional | PDF or Word |
|
FICA Refund Request
|
Use this form when an employee requests a prior year refund on FICA OASDI and MEDICARE. | PDF or Word |
|
Flexible Employment
Conversion Application |
Use this form to volunteer to reduce your time worked by one to six pay periods a year. | |
| This form has been replaced by the Waiver of Recruitment |
||
| Paper forms are no longer accepted. Please use eHire (accessed through My ASU). | Access eHire through My ASU |
|
I-O |
||
|
I -9
|
Form for Employment Eligibility Verification | External PDF |
|
I-9 Notary Instructions
|
Notary Instructions for New Employees Located Out of State | |
|
Independent Contractor Checklist
|
Use this form for review and approval of Independent Contractors before performance of services begins. | PDF Word Glossary |
LEAVES MANAGEMENT |
||
FOR EMPLOYEES |
||
| 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
|
||
| 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 |
|
Leave of Absence or Hold: |
Place employee on sabbatical, administrative leave or hold | |
| Leave of Absence or Hold: Business Reasons Status Change |
Return employee from 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 |
| return to top | ||
|
Name Change (ASU)
|
Form for employees to use to request a name change
|
|
|
Name Change/Change of Address (ASRS)
|
Form for employees who are ASRS members to request a name and/or address change. NOTE: Submit the completed form to ASRS, not ASU. |
|
|
Payroll and other HR forms for new hires. |
||
|
Non-Exempt Employee Calendar
|
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 |
|
Owner Automobile Mileage Report
|
Report of miles driven for dealer owned automobiles. | Word |
|
Out-of-State Employee |
Approval of Out-of-state Employee (New Hire or Relocation) | |
P |
||
|
Pay Option: |
Form used to select payment options for faculty on academic year appointments. | |
|
Payroll Action Request |
Form to be used by managers if additional payment needs to be made to a faculty or staff member | |
|
Payroll Packet
|
SEE NEW HIREPACKET | |
|
Payroll Redistribution
and Instructions |
Request a payroll expense transfer. | |
|
Performance Management
|
All of these forms are on the Performance Management website: Performance Evaluation--Management Performance Improvement Plan Staff Self-evaluation Sample Form |
|
|
Personal Data Change
|
Report changes to personal information (for current ASU employees) |
My ASU Use the My Profile tab (Upper right) |
|
Personnel File Request Form
|
ASU employees outside of the Office of Human Resources should use this form to request access to view an employee's personnel file | |
|
Post Offer of Employment
Physical Exam Sheet |
Use this form when requiring an employee to have a physical examination. | PDF or Word |
|
Pre-Employment Inquiry Form
|
To be filled out by job candidates before a background check or fingerprinting is done | |
| return to top | ||
R |
||
|
Recruitment Handbook
|
Use for guidance in recruiting faculty and academic professsionals | |
RETIREMENT PROGRAM |
||
GENERAL |
||
|
ADOA Retiree Health Insurance
Enrollment Form |
Administered by the Arizona Dept. of Administration (ADOA), Business Services Division | |
|
Declaration of Understanding/
Election of Retirement Plan |
Acknowledgement of 30-day election period. | |
|
Election of Retirement Option Form
|
Use to elect retirement option | |
|
Retirement Certificate Request
|
Form to request certificate to honor ASU employees who retire with five or more years of continuous service |
|
|
Vacation/Compensatory Time
Termination Worksheet |
Form used to calculate Vacation/Compensatory time for terminating employees. | |
ARIZONA STATE RETIREMENT SYSTEM (ASRS) |
||
|
Affidavit of Public Service
with ASRS Employer |
Use for Public Service Purchase | |
|
Affidavit of Military Service
|
Use for Military Service Purchase | |
| This waiver form must be filed with ASRS within 30 days of employment | ||
|
Arizona State Retirement System (ASRS)
|
Enrollment/Registration Instructions | Online |
|
ASRS Reimbursement of Medical and Dental Cost Instructions/Forms
|
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. | |
|
ASRS Retiree Return to Work
for an ASRS Employer |
Form to use when an ASRS retiree is returning to work for an ASRS employer | |
|
Name Change (ASU)
|
Form for employees to use to request a name change INSTRUCTIONS |
|
|
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 |
|
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 |
PUBLIC SAFETY PERSONNEL RETirEMENT SYSTEM (PSPRS) |
||
|
Change of Beneficiary Designation Form
|
Form to be completed when designating a new beneficiary for PSPRS | |
|
Lump Sum Distribution Election Form for Refunds
|
Use for refunds from PSPRS | |
|
Membership Form
|
For new PSPRS Members | |
|
Name or Address Change Form
|
Use to change name or address with PSPRS | |
RETIREE ACCUMULATED SICK LEAVE PROGRAM (RASL) |
||
|
Retiree Accumulated Sick Leave Program (RASL)
NOTE: The original RASL Application/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 Deferral Notification (OPTIONAL) Federal W-4 Arizona A-4 |
|
| return to top | ||
S |
||
SAMPLE LETTERS (RECRUITMENT)
|
||
|
Offer letters will be automated for all Staff, Student and Graduate Assistant hires through Kenexa BrassRing starting Nov. 18, 2013. The templates below are applicable only for the final recruitments being closed through PeopleSoft TAM.
|
||
|
Sample Offer Letters
|
Use these sample templates to confirm Classified or Service Professional employment offers. | HR Advisor |
|
Sample Non-select Letter (Applicant)
|
Use this form as a template to notify applicants that they were not selected. | HR Advisor |
|
Sample Non-select Letter (Interviewee)
|
Use this form to notify applicants that have been interviewed, that they were not selected. | HR Advisor |
|
Summer Address
|
Use this form to provide HR with your summer address information. | Word |
T-U |
||
|
Temporary Employment Request (External)
|
Use this form when completing a Temporary Employment Request with an external temporary agency. |
Word |
|
Temporary Employment Request (Internal)
|
Use this form when completing a Temporary Employment Request with Staffing Services. |
Word |
|
Timesheet
|
For non-exempt employees to manually record work time | Word |
|
Timesheet Enhancement
Documentation |
Technical info about enhancements made to the online timesheet for |
|
TUITION WAIVER PROGRAM |
||
|
Tuition Waiver (1)
|
Classes at any ASU campus: • Employee • Employee's spouse • Employee's dependent(s) |
|
|
Tuition Waiver (2)
|
Classes at UA or NAU: Classes at ASU, UA or NAU: For HR signatureFax the completed form to 480.965.1971 with instructions on where to return it. OR Bring the completed form to the HR Employee Service Center. |
|
|
Tuition Waiver
for ASU Domestic Partners and Dependents |
Tuition waiver form for domestic partners and their dependents
Qualified Domestic Partner Affidavit |
|
V-Z |
||
|
Vacation/Compensatory Time
Termination Worksheet |
Form used to calculate Vacation/Compensatory time for terminating employees. | |
|
Verification of Employment
|
Use this form to request a verification of employment. | |
|
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. | |
|
Faculty/Postdoc
Waiver of Recruitment |
This form replaces the Focused Recruitment Form and is applicable for Faculty and Postdoc Waivers of Recruitment. | PDF (NOTE: Works best with Internet Explorer) |
| Flow Chart Employer's Report of Injury Supervisor's Incident Report Authorization for Payment Release To Return to Work |
PDF External PDF |
|
| return to top | ||
