Benefits Forms
|
| Child of Domestic Partner Declaration of Tax Status Form |
PDF |
|
| Dependent Information Update Form |
PDF |
|
| Flexible Spending Account Claim Form - ASI |
PDF |
Additional Information |
| Flexible Spending Account Direct Deposit Sign Up Form |
PDF |
Additional Information |
| Flexible Spending Account Election Change Form |
PDF |
|
| Health Savings Account (HSA) Transfer Request Form |
PDF |
|
| HSA Voluntary Contribution Designation Form |
PDF |
|
| ORP Change of Election Form |
PDF |
|
| Qualified Domestic Partner Affidavit |
PDF |
|
| Qualified Life Event Form |
Word Doc |
|
| Termination of Domestic Partnership |
PDF |
|
Child-Care Forms
|
| Childcare Choice Employee Reimbursement Program for Qualified Childcare Expenses |
|
See LWC website |
| Childcare Choice - Employee Enrollment 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 |
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 |
Additional Information |
| Compassionate Transfer of Leave—Request to Forfeit Vacation Hours |
PDF |
Additional Information |
| Extended Leave of Absence Form - Classified Staff & University Staff |
MS Word |
Additional Information |
| 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 |
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 |
|
| Departmental Checklist for Employee Separation |
PDF |
|
| Signature Authorization List |
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
|
| Employment Eligibility Verification Form I-9 (Fillable electronically). Note: with some browsers you may get a "please wait" error message. Simply click "download" from this error page. The form will download to your device, where you can open it. |
Link |
Additional Information |
| Employment Eligibility Verification Form I-9 (This version is unfillable and must be printed for completion on paper only.) |
PDF |
|
| Hiring Form (Competitive and Non-Competitive) |
PDF |
|
| New Health Insurance Marketplace Coverage Notice |
PDF |
|
| New Hire Worksheet |
MS Word |
Additional Information |
| Person Information Form |
PDF |
|
| Self Identifier Ethnicity |
PDF |
|
| State of Arizona Employee Loyalty Oath |
PDF |
Additional Information |
| Veteran Status |
PDF |
|
| Voluntary Self ID of Disability |
PDF |
|
Offer Letters
|
| University Staff Offer Letter Builder |
Template |
|
| COM Offer Letter |
MS Word
|
|
| Faculty and Appointed Personnel Offer Letter Builder |
Template |
|
| Graduate Assistant/Associate Offer Letter Builder |
Link |
|
| Limited-term Faculty Service Offer Letter Builder |
Template |
|
| 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) |
Online Form |
|
| Request for Security Sensitive Status |
PDF |
|
Qualified Tuition Reduction Forms
|
| Application for Domestic Partner Tuition Program - Retirees only |
PDF |
This form is for retirees only. Active Employees should apply online in UAccess Employee. Click here for more information. |
| 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. Click here for more information. |
Retirement Forms
Retirement forms have been moved to the Road Ahead website.
UAccess Employee
|
| Electronic Manager Self Service (MSS) Forms |
Link |
|
| PAF (Personnel Action Form) |
Link |
|
