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Forms

Benefits Forms

Dependent Information Update Form PDF  
Child of Domestic Partner Declaration of Tax Status Form PDF  
Domestic Partner Change Form PDF  
HSA Voluntary Contribution Designation Form PDF  
Flexible Spending Account Election Change Form PDF  
Qualified Life Event Form PDF  
Qualified Domestic Partner Affidavit PDF  
Flexible Spending Account Claim Form - ASI PDF Additional Information
Flexible Spending Account Direct Deposit Sign Up Form PDF Additional Information

Child-Care Forms

Employee Child Care Voucher Program Application   See LWC website
Employee Child Care Voucher Program Provider Verification Form   See LWC website
Sick Child and Emergency/Back-Up Care Program for Employees   See LWC website
Sick Child and Emergency/Back-Up Care Program for Students   See LWC website

Coaching and Discipline

Discharge Memo Format (For Regular Classified Staff) Template Additional Information
Disciplinary Probation Memo Format (For Regular Classified Staff) Template Additional Information
Disciplinary Suspension Memo Format (For Regular Classified Staff) Template Additional Information
Initial Probation Termination Memo Format (For Classified Staff on Initial Six-Month Probation Period) Template Additional Information
Investigative Leave with Pay Memo Format (For Regular Classified Staff) Template Additional Information
Job Abandonment Letter Format Template Additional Information
Pre-discharge or Pre-suspension Meeting Memo Format (For Regular Classified Staff) Template Additional Information
Promotion/Transfer Probationary Period Performance Improvement Memo Format (For Classified Staff on a Promotion/Transfer Probationary Period) Template Additional Information
Promotion/Transfer Probationary Period Termination Notice Format (For Classified Staff on a Promotion/Transfer Probationary Period) Template Additional Information
Written Warning Memo Format (For Regular Classified Staff) Template Additional Information

Compensation Forms

9/12 Pay Plan Option Enrollment Agreement PDF Additional Information
Return to 9/9 Pay Plan PDF Additional Information
Request for In-Classification Career Progression Form PDF Additional Information
Supplemental Compensation Form-Appointed Personnel PDF Additional Information
Supplemental Compensation Form-Classified Staff PDF Additional Information
Supplemental Compensation Form-Graduate Assistants/Associates PDF Additional Information

Designated Campus Colleagues (DCC)

Affiliate Verification Form PDF  
Designated Campus Colleague Worksheet MS Word  
Intermittent/Occasional Volunteer Worksheet MS Word  
Intermittent Volunteer Agreement (Macro-enabled Word document) MS Word  
Intern-Department Worksheet MS Word  

Leave of Absence Forms

Compassionate Transfer of Leave Contribution Form PDF Additional Information
Compassionate Transfer of Leave Request Form PDF Additional Information
Extended Leave of Absence Form - Classified Staff MS Word Additional Information
FMLA: Employee Request for Family and Medical Leave PDF  
FMLA: Notice of Eligibility and Rights & Responsibilities PDF  
FMLA: Designation Notice PDF  
FMLA: Certification of Health Care Provider for Employee’s Serious Health Condition PDF  
FMLA: Certification of Health Care Provider for Family Member’s Serious Health Condition PDF  
FMLA: Certification of Qualifying Exigency for Military Family Leave PDF  
FMLA: Certification for Serious Injury or Illness of a Current Servicemember - For Military Family Leave PDF  
FMLA: Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave PDF  
Leave Of Absence Unpaid - Appointed Personnel: Template For Department Head Approval/Denial of Employee Request Template  
Leave Of Absence Unpaid - Appointed Personnel: Template For Department Request to the Provost Template  
Leave Of Absence Unpaid - Appointed Personnel: Template For Employee Request to Department Head Template  
Paid Parental Leave

MS Word

 

Miscellaneous Forms

Department Request Form for UAccess Learning Form  
Notice of Appointment for Graduate Assistants and Associates PDF  
Request for Time In Position Waiver PDF Additional Information

New Hire Forms

** These forms are only used for processing approved exceptions to the new hire process in UAccess. **

The individual forms listed below are also contained in the New Hire Forms Packet (PDF).

Employment Eligibility Verification (Form I-9) Link Additional Information
Hiring Form (Competitive and Non-Competitive) PDF  
New Health Insurance Marketplace Coverage Notice PDF  
Person Information Form PDF  
State of Arizona Employee Loyalty Oath PDF Additional Information
Self Identifier Ethnicity PDF  
Veteran Status PDF  
Voluntary Self ID of Disability PDF  

Offer Letters

COM Offer Letter MS Word  
Classified Staff Offer Letter Builder Template  
Faculty and Appointed Personnel Offer Letter Builder Template  
Limited-term Faculty Service Offer Letter Builder Template  
Graduate Assistant/Associate Offer Letter Builder Link   
College of Medicine Clinical Assistant Exception Pay Authorization Form PDF  

Performance Evaluation Forms

3 Point Feedback MS Word  
Performance Feedback for Individual Contributors MS Word  
Performance Feedback for Managers and Supervisors MS Word  
Performance Feedback / Five-Point Rating Format MS Word  
Factors and Standards Format / Performance Appraisal MS Word Additional Information
Narrative Format / Performance Appraisal MS Word Additional Information
Objectives, Factors and Standards Format / Performance Appraisal MS Word Additional Information
Performance Feedback for Individual Contributors MS Word Additional Information
Performance Feedback for Managers and Supervisors MS Word Additional Information
Traditional Eight-factor Report of Performance Appraisal MS Word Additional Information

Pre-Employment & Background Checking Forms

Adverse Action Notice (Candidate) MS Word  
Adverse Action Notice (Employee) MS Word  
Candidate Consent and Disclosure Form PDF  
Employment Reference Release Form MS Word  
Pre-Adverse Action Notice MS Word  
Request for Criminal Background/DMV Check (for Positions not Maintained in UACareers or Career Track) Online Form  
Request for Security Sensitive Status PDF  
Summary of Rights under FCRA PDF  
UA CDL Release Form MS Word  

Qualified Tuition Reduction Forms

Application for Qualified Tuition Reduction - Retirees, UA affiliates and employees on LTD only PDF This form is for retirees, UA affiliates and employees on Long Term Disability only. Active employees should apply online in UAccess EmployeeClick here for more information.
Application for Domestic Partner Tuition Program - Retirees only PDF This form is for retirees only. Active Employees should apply online in UAccess EmployeeClick here for more information.

Recruitment Forms

Faculty Search Plan Worksheet PDF  

Retirement Forms 

Retiree Accumulated Sick Leave (RASL) Form (GAO-SL-50) PDF Additional Information
Retiree Accumulated Sick Leave Checklist for University Employees
(Submit with RASL form)
PDF Additional Information
Retiree Accumulated Sick Leave Federal Taxes
(Submit with RASL form)
PDF Additional Information
Employee's Arizona Withholding Election (Submit with RASL form) PDF Additional Information
Retiree Accumulated Sick Leave Nationwide - Deferral Notification Form
(Submit with RASL form - if applicable)
PDF Additional Information
2016 Retiree Health Benefits Enrollment Form - ADOA PDF Additional Information
2016 Group Participant Medicare Part D Enrollment Form - ADOA PDF Additional Information
Phased Retirement Program Agreement Template and Age Discrimination in Employment Act Disclosure PDF  

Termination, Layoff and Non-renewal

Layoff - FTE Reduction (below .50 FTE) Notification Memo Format for Regular Classified Staff (who have completed the initial six month probation) Template Additional Information
Layoff Notification Memo Format for Regular Classified Staff (who have completed the initial six month probation) Template Additional Information
Nonrenewal Notification Memos for Appointed Personnel   Contact HR Consulting