Forms

Benefits Forms
Child of Domestic Partner Declaration of Tax Status Form	PDF
Dependent Information Update Form	PDF
Flexible Spending Account Claim Form - ASI	PDF	Visit Flexible Spending Accounts page
Flexible Spending Account Direct Deposit Sign Up Form	PDF	Visit Flexible Spending Accounts page
Flexible Spending Account Election Change Form	PDF
HSA Voluntary Contribution Designation Form	PDF
ORP Change of Election Form	PDF
Qualified Domestic Partner Affidavit	PDF
Qualified Life Event Form	PDF
Termination of Domestic Partnership	PDF

Compensation Forms
9/12 Pay Plan Option Enrollment Agreement	PDF	Additional Information
Contract Rate Adjustment Request	PDF
Incumbent Review Request Form	PDF
Other Professional Services Form (OPS)	PDF	Additional Information
Position Description Form	PDF	How to Write a Position Description
Return to 9/9 Pay Plan	PDF	Additional Information
Salary Increase Worksheet	PDF
Transition to University Staff Form	PDF

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

Leave of Absence Forms
Compassionate Transfer of Leave Request Form	PDF	Compassionate Transfer of Leave page
Compassionate Transfer of Leave—Request to Forfeit Vacation Hours	PDF	Compassionate Transfer of Leave page
Extended Leave of Absence Form - Classified Staff & University Staff	MS Word	Personal Leave of Absence policy
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
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: Designation Notice	PDF
FMLA: Employee Request for Family and Medical Leave	PDF
FMLA: Notice of Eligibility and Rights & Responsibilities	PDF
Leave Of Absence Unpaid - Appointed Personnel: Template For Department Head Approval/Denial of Employee Request	MS Word
Leave Of Absence Unpaid - Appointed Personnel: Template For Department Request to the Provost	MS Word
Leave Of Absence Unpaid - Appointed Personnel: Template For Employee Request to Department Head	MS Word
Paid Parental Leave Request Request for Miscarriage/Stillbirth Recovery Leave	PDF PDF

Miscellaneous FormS
Departmental Checklist for Employee Separation	PDF
Signature Authorization List	PDF	Signature Authorization List instructions

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) New Hire Forms Packet (PDF)
Employment Eligibility Verification Form I-9 (version date 08/01/23)	PDF	Employment Eligibility and Identity and Social Security policy Form I-9 Instructions
Health Insurance Marketplace Coverage Notice	PDF
Hiring Form (Competitive and Non-Competitive)	PDF
New Hire Worksheet	MS Word	HR Workforce Systems Forms page
Person Information Form	PDF
Self Identifier Ethnicity	PDF
State of Arizona Employee Loyalty Oath	PDF	Loyalty Oath policy
Veteran Status	PDF
Voluntary Self-Identification of Disability	PDF

Offer Letters
University Staff Offer Letter – Interim Assignment	MS Word
University Staff Offer Letter – Acting Assignment	MS Word
Faculty and Appointed Personnel Offer Letter Builder	Template
Graduate Assistant/Associate Offer Letter Builder	Template	Must be on campus or using campus VPN to view
Limited-term Adjunct Offer Letter	MS Word
Tenure Eligible/Continuing Eligible Review Date Calculator	Link

Pre-Employment & Background Checking Forms
Background Screening Consent Form	PDF
Background Screening Disclosure Form	PDF
Employment Reference Release Form	MS Word
Summary of Rights under FCRA	PDF
Request for Criminal Background/DMV Check (for Positions not Maintained in Talent)		This form is no longer available. Effective 6/25/2021 Background Check Requests are submitted in UAccess Manager Self Service. Questions? Contact preemployment@arizona.edu.
Request for Security Sensitive Status	PDF	This form is under revision. Please contact the HR Background Check Team for assistance: preemployment@arizona.edu

Qualified Tuition Reduction Forms Visit the EDucational BEnefits PAge 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 Employee.
Application for Qualified Tuition Reduction - Retirees lacking online access and employees on LTD only	PDF	This form is for retirees,and employees on long-term disability only. Active employees and affiliates should apply online in UAccess Employee.

Qualified Tuition Reduction Forms

Visit the EDucational BEnefits PAge for more INFORMATION

Application for Domestic Partner Tuition Program - Retirees only

This form is for retirees only. Active Employees should apply online in UAccess Employee.

Application for Qualified Tuition Reduction - Retirees lacking online access and employees on LTD only

This form is for retirees,and employees on long-term disability only. Active employees and affiliates should apply online in UAccess Employee.

Retirement forms have been moved to the Road Ahead website.

UAccess Employee
Electronic Manager Self Service (MSS) Forms	UAccess
PAF (Personnel Action Form)	Link

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)		Contact Senior HR Partners Layoff/Reduction in Force Policy
Layoff Notification Memo Format for Regular Classified Staff (who have completed the initial six month probation)		Contact Senior HR Partners Layoff/Reduction in Force Policy
Nonrenewal Notification Memos for Appointed Personnel		Contact Senior HR Partners University Handbook for Appointed Personnel
Reorganization or Reduction in Force for University Staff		Contact Senior HR Partners Layoff/Reduction in Force Policy