Business and Finance.

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

FORMS FOR ACADEMIC PERSONNEL

FORM NAME

PURPOSE/DESCRIPTION

FORMAT

A-C

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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.) PDF
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.

Word

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.

PDF

Pre-Employment Inquiry Form

PDF

Driver's License Authorization

PDF

Request for Security or Safety Sensitive Position

DOC

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 PDF
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BENEFITS PROGRAM

 
BENEFITS
Effective on or after Jan. 1, 2011

 

 

 

 

 

2014 Benefits Enrollment/Change Form

PDF

 

Benefits Enrollment Process
Same-sex Domestic Partner and/or Child/Children

PDF

2014 HSA Payroll Deduction Authorization

PDF

IMPORTANT: See Retirement Info below.

FLEXIBLE SPENDING ACCOUNTS

Claim Form
University employees must use the Arizona Board of Regents FSA Claim Form 
External Page
Direct Deposit/Email Notification External PDF

Healthcare FSA Benny Card Application

PDF

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. PDF
Dissolution of Domestic Partnership
Use this form to report the termination of your domestic partnership. PDF
Long-term Disability

ADOA health insurance enrollment form for employees approved by the insurance carrier to receive LTD benefits PDF
Name Change (ASU)

Form for employees to use to request a name change
INSTRUCTIONS

 

PDF

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) PDF
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. PDF
Transition of Care
Use this form to request continuation of medical care with a provider who is not in your chosen network. PDF
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. PDF
Medical Claim Forms

Forms used to claim medical expenses:

United Healthcare
Aetna
AmeriBen
Cigna

PDF
PDF

PDF
PDF

Vision Plan Out-of-Network Claim
Use to claim out-of-network vision benefits. 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. PDF
Data Management EFax Cover Sheet
Use when you are efaxing documents to Data Management PDF
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. PDF
Emergency Hire
This form, used to fill an open position that needs an immediate hire, has been replace by the Waiver of Recruitment form. PDF

EMPLOYEE ASSISTANCE OFFICE
New Client Paperwork

Download and fill out these forms (.pdfs) before your first appointment with EAO ASU Employee

Family/Spouse/Partner

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 PDF
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. PDF
Focused Recruitment Form
This form has been replaced
by the Waiver of Recruitment
PDF
Hiring Process Report
Paper forms are no longer accepted. Please use eHire (accessed through My ASU). Access eHire
through My ASU

I-O

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I -9
Form for Employment Eligibility Verification External PDF
I-9 Notary Instructions
Notary Instructions for New Employees Located Out of State PDF
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 PDF
Authorization to donate hours PDF
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 PDF
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:
Business Reasons

Place employee on sabbatical, administrative leave or hold PDF
Leave of Absence or Hold:
Business Reasons Status Change
Return employee from sabbatical, administrative leave or hold PDF
Leave of Absence Status Change Change type, date, pay or employee status of a leave PDF
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)

Form for employees to use to request a name change
INSTRUCTIONS

 

PDF

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

New Hire Packet

Payroll and other HR forms for new hires.
IMPORTANT: DO NOT PRINT TWO-SIDED.
These forms must be single-sided for efaxing later.

PDF

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)

PDF

P

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Pay Option:
Faculty/Academic Professionals (AP)

Form used to select payment options for faculty on academic year appointments. PDF

Payroll Action Request

Form to be used by managers if additional payment needs to be made to a faculty or staff member PDF
Payroll Packet
  SEE NEW HIREPACKET
Payroll Redistribution
and Instructions
Request a payroll expense transfer.

PDF
Excel
Instructions

Performance Management

All of these forms are on the Performance Management website:

Performance Evaluation--Management
Performance Evaluation--Staff

Performance Improvement Plan
Performance Development Plan Template

Staff Self-evaluation Sample Form
Manager  Self-evaluation Sample Form

Performance Management Online

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 PDF
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 PDF
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R

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Recruitment Handbook
Use for guidance in recruiting faculty and academic professsionals PDF

RETIREMENT PROGRAM

GENERAL

ADOA Retiree Health Insurance
Enrollment Form
Administered by the Arizona Dept. of Administration (ADOA), Business Services Division PDF
Declaration of Understanding/
Election of Retirement Plan
Acknowledgement of 30-day election period. PDF
Election of Retirement Option Form
Use to elect retirement option PDF
Retirement Certificate Request
Form to request certificate to honor ASU employees who retire
with five or more years of continuous service
PDF
Vacation/Compensatory Time
Termination Worksheet
Form used to calculate Vacation/Compensatory time for terminating employees. PDF

ARIZONA STATE RETIREMENT SYSTEM (ASRS)

Affidavit of Public Service
with ASRS Employer
Use for Public Service Purchase PDF
Affidavit of Military Service
Use for Military Service Purchase PDF
Age 65+ Membership Waiver Form
This waiver form must be filed with ASRS within 30 days of employment PDF
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. PDF
ASRS Retiree Return to Work
for an ASRS Employer
Form to use when an ASRS retiree is returning to work for an ASRS employer PDF
Name Change (ASU)
Form for employees to use to request a name change
INSTRUCTIONS
PDF
Name/Address Change(ASRS)
For ASRS members who need to change their name and/or address in the ASRS records and systems MyASRS Secure Website
Withdrawal of Contributions and Termination
of Membership
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 PDF
Lump Sum Distribution Election Form for Refunds
Use for refunds from PSPRS PDF
Membership Form
For new PSPRS Members PDF
Name or Address Change Form
Use to change name or address with PSPRS PDF

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

PDF

PDF

PDF

PDF

PDF

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S

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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

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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
hourly non-exempt and student employees paid from project sponsored accounts

PDF

TUITION WAIVER PROGRAM

Tuition Waiver (1)
Classes at any ASU campus:
• Employee
• Employee's spouse
• Employee's dependent(s)

Word
PDF

Tuition Waiver (2)

Classes at UA or NAU:
• Employee,
• Employee spouse
• Employee dependent(s)

Classes at ASU, UA or NAU:
• Retiree, their spouse and their dependent(s)
• Eligible LTD participant, their spouse and their dependent(s)
• Affiliate, their spouse and their dependent(s)

For HR signature

Fax 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.

Word
PDF

 

Tuition Waiver
for ASU Domestic Partners and Dependents

Tuition waiver form for domestic partners and their dependents

 

Qualified Domestic Partner Affidavit

Word
PDF

 

PDF

   

V-Z

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Vacation/Compensatory Time
Termination Worksheet
Form used to calculate Vacation/Compensatory time for terminating employees. PDF
Verification of Employment
Use this form to request a verification of employment. PDF
W-2 Request
Use this form to request a duplicate copy of a W-2 or 1042S PDF
W-4
Employee's Federal Income Tax Withholding Allowance Certificate PDF
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. PDF
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)
Workers' Compensation
Flow Chart
Employer's Report of Injury
Supervisor's Incident Report
Authorization for Payment
Release To Return to Work
PDF
External PDF
PDF
PDF
PDF
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