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.


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.
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 Important: See the retirement section below.
COBRA Administered by the Arizona Department of Administration, Benefits Services Division.
Family adoption and fertility benefits
Flexible Spending Accounts
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
Vision plan out-of-network claim Used to claim out-of-network vision benefits.


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.


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
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
Name change - ASU
  1. Review our policy about requesting a name change.
  2. Complete the application for a name change.
  3. 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


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

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.    


Name Purpose - Description
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 program

Forms are submitted online. Visit the qualified tuition reduction program webpage for additional details about the program. 

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.


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.