Adoption Reimbursement Form
Bombeck Family Learning Center Discount
Continuing Education
Dental Care Forms
EyeMed Vision Plan
Flexible Spending Forms
 Health Care Forms
Hiring Forms
Leave/Sabbatical Form
 Life & Other Insurance Forms
 Long Term Care
 Long Term Disability Form
 Non-Faculty Hiring Forms
 Outside Employment & Additional Services Approval Form
Payroll Direct Deposit
 Performance Management Forms
Personnel Action Form (PAF)
 Position Description & Classification Review Forms
 Request for Change of Personal Data Form
Retirement Forms
 Staffing Forms
 Tax Forms
Tuition Exchange
Tuition Remission
 Union Hiring Forms
 Vacation & Sick Leave Usage Forms
 Worker's Compensation Claim Form

Forms listed below as Adobe require Adobe Acrobat to view and print.
(click on the words Adobe Acrobat above to download the software).

Health Care Forms

ENROLLMENT FORMS

Indicate your plan choice by writing "Core" or "Advantage" in section 4 on the Anthem enrollment form titled "Type of Coverage/Plan."

Anthem Healthcare Enrollment/Change Form  (pdf)

 

MEDICAL CLAIM FORMS

Anthem Medical Claim

PRESCRIPTION FORMS

Anthem NextRx Mail Order (PDF)

Anthem Rx Order Retirees Over 65 Only (PDF)

Prescription Drug Claim Form (PDF)

 

WAIVER FORMS

Employee Health Care Waiver Form (PDF)

Graduate Assistant Health Care Waiver Form (Word)

Retiree Health Care Waiver Form (PDF)

Life & Other Insurance Forms

CNA Group
 

UnumProvident Life Insurance Form

UnumProvident Evidence of Insurability Form

UnumProvident Beneficiary Designation Form

UnumProvident Accidental Death & Dismemberment Form

Waiver of Entitlement to Group Term Life Insurance
(in Excess of $50,000)

Long Term Care

Long Term Care Enrollment Form

Long Term Care Summary  - for detailed information contact HR

Long Term Disability

Long Term Disability Form

UnumProvident Evidence of Insurability Form

Position Description & Classification Review Forms

Position Description Form and Guidelines

Position Description Guidelines only

Position Classification Review Form

Position Description Form

Union Hiring Forms

Union Recruitment/Hiring Packet

Vacation & Sick Leave Usage Forms

Sick Leave Usage

Vacation Usage
 

Staffing Forms

    Personnel Requisition Form (Non-Faculty Positions) (MS Word)

    Position Description (MS Word)      

    Position Description & Guidelines (pdf)

    Essential Position Functions (MS Word)

    Applicant Rating Worksheet (Excel)

    Interview Evaluation Form (MS Word)

    Employment Recommendation Form (Non-Faculty and Union Positions) (MS Word)

    Employment Application (MS Word)

    Internal Employment Application (MS Word)

    Background Check Release (MS Word)

Continuing Education Forms

    Instructions for Participants

Tuition Remission

    Tuition Remission Application for Employee (MS Word)

    Tuition Remission Application for Child or Spouse (MS Word)

Dental Forms

    Superior Dental Enrollment Form

    Dental Waiver Form (Word)

 Retirement Forms

    Salary Reduction Agreement

    Fidelity Investments 403(b) Beneficiary Designation Form

    TIAA CREF Beneficiary Designation Form

 Adoption Reimbursement Form

    Adoption Reimbursement Form

 EyeMed Vision Plan

    EyeMed Out-of-Network Claim Form

 Tax Forms

    Federal Withholding Certificate (W-4)

    State of Ohio Withholding Certificate (IT-4)