Human Resources

HUMAN RESOURCES

AFFIRMATIVE ACTION

BENEFITS

EMPLOYEE RELATIONS

EMPLOYMENT

UpcomingEvents
.................................................

	30	Dean of LAS candidate: Scott Sprenger
.................................................
	6	Dean of LAS candidate: Susanne Monahan
.................................................
	8	Dean of LAS candidate: Steven Combs

Dean of LAS candidate evaluations

Forms

Pay Forms

Cell Phone Allowance
Direct Deposit
Employment Authorization (Instructions)
Pay Adjustment/ Overload
Request for Cash-Out of Vacation Leave (Classified Employees)
Request for Payroll Advance /Draw
W-4

Recruitment Forms

Authorization to Fill a Position (Instructions)
Request to Review Applications Online

Application Forms

Classified Employment
Unclassified /Faculty Employment

Benefits Forms

PEBB Enrollment Forms

PEBB Employee Enrollment
PEBB Affidavit of Dependency
PEBB Affidavit of Domestic Partnership
PEBB Flexible Spending Account
UNUM Long-Term Care Enrollment
Medical History Statement (Printable)
Medical History Statement (Submit Online)
Weight Watchers Enrollment

PEBB Benefit Update Forms

PEBB Mid-Year Change
PEBB Mid-Year Tobacco Use
PEBB Domestic Partnership Termination
ASI Flexible Spending Account Update
ASI Flexible Spending Direct Deposit Update

Retirement Forms

PERS IAP Pre-Retirement Designation of Beneficiary
PERS IAP Retirement Designation of Beneficiary
ORP Election/Enrollment/PERs Transfer
ORP Change
TDI 403(b) Salary Reduction Agreement
The Standard Optional Life Insurance Portability
The Standard Retiree Life Insurance Conversion Packet
UNUM Long Term Care Continuation

PEBB Benefit Claim Forms

ASI Flex
ASI Flex (File Online)
Life Insurance Claim

Staff Fee Privilege Forms

Staff Fee (Employee)
Staff Fee (Family Transfer)
Staff Fee Affidavit of Domestic Partnership

Performance Appraisal Forms

Classified Performance Appraisal
IT Performance Appraisal (Instructions)
Unclassified Performance Appraisal

Position Descriptions & Request For Review Forms

Classified Position Description
Unclassified Position Description
Request for Position Review (Classified & Unclassified)

Travel Reimbursement Forms

Pre-Travel Authorization
Travel Reimbursement
Prospective Employee Travel Reimbursement Approval Request
New Employee Moving & Relocation Expense Reimbursement Request
International Insurance for Employees Traveling Abroad

Injury Report /Worker's Compensation (SAIF) Forms

Supervisor's Occupational Injury Report (All employees, including student employees)
SAIF 801 (Only if medical attention is received)
SAIF 801 en Espanol

Americans with Disabilities Act (ADA) Forms

ADA Accommodations Request

Staff Development Forms

Staff Development Fund Request

New Employee Paperwork Forms

Direct Deposit
I-9
New Employee Information
New Employee Statistics (Optional)
W-4

Payment Plan
Classified (Full-Time)
Classified (Part-Time)
Graduate Teaching Assistant
Non-Tenure Track Faculty
Temporary Employment
Unclassified /Faculty (9-Month)
Unclassified /Faculty (12- Month)
Unclassified/ Faculty (Hourly)

Departure Forms

Departure Checklist
Exit Questionnaire (Optional)
Life Insurance Portability
Long Term Care Continuation of Coverage

FMLA Forms

Certification of Health Care Provider (Employee)
Certification of Health Care Provider (Family Member)
Fitness for Duty
FMLA Attendance Record
Hardship Leave Application
Hardship Leave Donation Form
Leave Request
Leave Arrangement Request
Release to Return to Work

Contact

Office of Human Resources 503-838-8490 | or e-mail: fordhamk@wou.edu