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| A | B | C | D | E | F |  H-I | J | L | M | N | O-P | R | S | U | V | W |

NOTE: Please use the following site to lookup the employee number; this number may be used in place of the social security number when completing forms found on this site. http://eelookup.admsrv.ohio.edu/eelookup/

Forms on this site are available in one of the following formats: Microsoft Word, Microsoft Excel and Adobe Acrobat.

You can receive a FREE version of Adobe Acrobat by visiting http://www.adobe.com/.

A- Forms
Anthem Medical Claim

Addendum to Administrative/Faculty Appointment for Unpaid Leaves
Administrators, Performance Development Assessment
AFSCME Performance Evaluation
Annual Certification of Emergency Services Status
Anthem, Dental Claim
Anthem Student Certification
Application for Family or Medical Leave  (OU FMLA #.01) 
ARP Vendor Change
Award Request, Employee

UP

B- Forms
Bargaining Unit Performance Evaluation
Beneficiary, Life Insurance
Benefits Enrollment (Microsoft Word)

Benefits, Dental Claim (Anthem)
Benefits, Evidence of Insurability Form
Benefits, Flexible Spending Account Reimbursement FlexPro 

Benefits, Mail Order Prescription
Benefits, Medical Claim (Anthem)
Benefits, Medical Claim
Benefits, Prescription Reimbursement (Rx Options)
Benefits, Vision - (Faculty & Administrative Only)
Benefits, Waiver to Stop Automatic Rollover FlexPro
Benefits, Waiver of Group Health Insurance 

UP

C- Forms
Campus Directory, Update
Certification of Need for Leave Adoption or Foster Care (OU FMLA #.06)
Certification of Physician/ Health Care Provider Employee (OU FMLA #.04)
Certification, Student
Change, Employee Personal Data
Child, Educational Benefit 2008 (Excel)
Child, Educational Benefit 2007 (Excel)
Classification Review
Classified, Interim Base Wage Adjustment
Classified Non Bargaining, Probationary Evaluation
Comp Time

UP

D- Forms
Data Profile, Personnel
Dental Claim (Anthem)
Disability, OPERS (Print DR1, DR2, DR3, DR4, HC1)
Disability, Reliance (Return to Human Resources)
DMA, Homeland Security
Domestic Partner, Affidavit of Same Sex
Domestic Partner, Educational Benefit 2007
Domestic Partner, Educational Benefit 2008
Domestic Partner, Enrollment
Domestic Partner, Statement of Termination
Domestic Partner, Tax Information

UP

E- Forms
Educational Benefit, Employee 2009 (Excel)
Educational Benefit, Employee 2009 (pdf)
Educational Benefit, Employee 2008 (Excel)
Educational Benefit, Employee 2008 (pdf)
Educational Benefit, Qualified Dependents 2009 i.e. Spouse, Child, Domestic Partner (Excel)
Educational Benefit, Qualified Dependents 2009 i.e. Spouse, Child, Domestic Partner (pdf)
Educational Benefit, Qualified Dependents 2008 i.e. Spouse, Child, Domestic Partner (Excel)
Educational Benefits Qualified Dependents 2008 i.e. Spouse, Child, Domestic Partner (pdf)
EEO/AA Appraisal (Institutional Equity)
Employee Award Request
Employee Personal Data Change Notice
Employee Recognition, (Appendix A)

Employment Interviewer Evaluation
Employment Separation Checklist
Employment Verification, I-9
Enrollment, Benefits (Microsoft Word)
EnvisionRx, Mail Order Prescription
ERIP Statement of Intent

Evidence of Insurability
RETURN TO:
Fort Dearborn Life Insurance Company, Attn: Medical Underwriting Dept.
P.O. Box 655403, Dallas, TX 75265-5403, Fax: 1-972-996-9371

Exit Interview Questionnaire

UP 

F- Forms
Family Medical Leave Act (FMLA): Application for Family or Medical Leave (OU FMLA #.01)
Family Medical Leave Act(FMLA): Notice to Employees (OU FMLA #.02)
Family Medical Leave Act (FMLA): OU Response to Employee Request for FMLA (OU FMLA #.03)
Family Medical Leave Act(FMLA): Certification of Physician/ Health Care Provider Employee) (OU FMLA #.04)
Family Medical Leave Act (FMLA): Medical Certification Statement (Family Member) (OU FMLA #.05)
Family Medical Leave Act (FMLA): Certification of Need for Leave Adoption or Foster Care  (OU FMLA #.06)
Flexible Spending Account, Dependent Care, WageWorks 
Flexible Spending Account, Healthcare, WageWorks
Fort Dearborn Life, Evidence of Insurability
FTE Reduction, Voluntary

UP

H-I- Forms
Homeland Security, DMA

I-9 Employment Verification

Interim Base Wage Adjustment (Classified)
Interview, Employment Evaluation
Interviewer Evaluation
IPS, Mail Order Prescription

UP

J- Forms
Job Information Questionnaire (JIQ) - Classified
Job Information Questionnaire (JIQ) - IT

UP

L- Forms
Leave of Absence (Classified employees)
Leave of Absence/Work Related Injury
Leave,Organ Donation
Leaves, Unpaid- Addendum for Administrative/Faculty Appointments
Life Insurance Beneficiary

UP

M- Forms
Mail Order Prescription
Medical Certification Statement (Family Member) (OU FMLA #.05)
Medical Claim, Anthem

Mid-Year Base Wage Adjustment (Classified)

UP

N- Forms
Notice to Employees (OU FMLA #.02)

UP

O, P- Forms
Organ Donation Leave, Request for
Paid Time Off: Faculty and Staff (Excel)
Paid Time Off: Faculty and Staff (pdf)
Performance Development Assessment, Administrators
Performance Evaluation, AFSCME
Performance Management, Employee Activity Journal PM4
Performance Management, Employee Activity Journal PM4 (pdf)
Performance Management, Employee Self Evaluation PM5
Performance Management, Employee Self Evaluation PM5 (pdf)

Performance Management Review, Classified PM1*
Performance Management Review, Classified PM1 (pdf)*

Performance Appraisal for Classified Staff*
Performance Management, Supervisor Feedback PM3
Performance Management, Supervisor Feedback PM3 (pdf)
Performance Planning PM2
Performance Planning PM2 (pdf)
Personal Data Change Notice
Personal Time: Administrators (Excel)
Personal Time: Administrators (pdf)
Personnel Data Profile
Position Description Questionnaire (PDQ)
Position Modification Form (to be used when modifying title and/or content of position)
Position Search Committee Reference Check
Prescription, Mail Order
Prescription Reimbursement (Rx Options)
Prior State Service Request for Transfer
Probationary Evaluation, Classified Non Bargaining

*May use either Performance Appraisal or PM1 form.

UP

R- Forms
Recognition, Employee (Appendix A)
Reliance Disability (Return to Human Resources)

Request for Emergency Service Leave
Request for Organ Donation Leave
Request for Paid Time Off, Administrative
Resignation Form
Response to Employee Request for FMLA (OU FMLA #.03)

UP

S- Forms
Sample Offer Letter Administrator
Search Firm Recruitment Report- Part A
Search Firm Recruitment Report- Part B
Separation Checklist, Employment
Sick Leave: AFSCME Bargaining Unit Employees (Excel)
Sick Leave: AFSCME Bargaining Unit Employees (pdf)
Sick Leave: Classified Employees (Excel)
Sick Leave: Classified Employees (pdf)
Sick Leave, Conversion
Sick Leave: Faculty and Staff (Excel)
Sick Leave: Faculty and Staff (pdf)
Spouse, Educational Benefit

State Service, Prior (Request for Transfer)
Student Certification, Anthem
Supervisor Feedback PM3
Supervisor FeedbackPM3 (pdf)   

UP

U- Forms
Unacceptable Behavior Incident Report
Unpaid Leaves- Addendum for Administrative/Faculty Appointment

UP

V- Forms
Vacation: Faculty and Staff (Paid Time Off) Excel
Vacation: Faculty and Staff (Paid Time Off) pdf
Vision Claim (Anthem) (Faculty & Administrators)
Voluntary FTE Reduction

UP

W- Forms
WageWorks, Flexible Spending Account- Dependent Care 
WageWorks, Flexible Spending Account- Healthcare
Waiver of Group Health Insurance, Benefit

UP

Ohio University Human Resources
169 West Union Street
Human Resources and Training Center
Athens, OH 45701
Phone: (740) 593-1636 | Fax: (740) 593-0386
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