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
Addendum to Administrative/Faculty Appointment for Unpaid Leaves
Address Change (Personal Data Change Notice)
Administrators, Performance Development Assessment
Adoption Benefit Financial Reimbursement Form
AFSCME Performance Evaluation
Anthem, Dental Claim
Anthem International Claim, BlueCard Worldwide®
Anthem Medical Claim
Anthem Student Certification
ARP Vendor Change
Award Request, Employee
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B- Forms
Bargaining Unit Performance Evaluation
Beneficiary, Life Insurance
Benefits Enrollment (Microsoft Word)
Benefits Enrollment (pdf)
Benefits, Dental Claim (Anthem)
Benefits, Evidence of Insurability Form
Benefits, Flexible Spending Account Reimbursement FlexPro
Benefits, Medical Claim (Anthem)
Benefits, Medical Claim
Benefits, Vision - (Faculty & Administrative Only)
Benefits, Waiver to Stop Automatic Rollover FlexPro
Benefits, Waiver of Group Health Insurance
BlueCard Worldwide®, Anthem International Claim
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C- Forms
Campus Directory, Update
Certification, Student
Change, Employee Personal Data
Classification Review
Classified Development Program (CDP) Application
Classified, Interim Base Wage Adjustment
Classified Non Bargaining, Probationary Evaluation
Comp Time
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D- Forms
Data Profile, Personnel
Dental Claim(Anthem)
Disability, OPERS (Print DR1 & DR3)
Disability, Reliance (Return to Human Resources)
DMA, Homeland Security
Domestic Partner, Affidavit
Domestic Partner, Enrollment
Domestic Partner, Statement of Termination
Domestic Partner, Tax Information
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E- Forms
Educational Benefit, Employee 2010 (Word)
Educational Benefit, Employee 2010 (pdf)
Educational Benefit, Qualified Dependents 2010 i.e. Spouse, Child, Domestic Partner (Word)
Educational Benefit, Qualified Dependents 2010 i.e. Spouse, Child, Domestic Partner (pdf)
Educational Benefit, Employee 2009(Excel)
Educational Benefit, Employee 2009(pdf)
Educational Benefit, Qualified Dependents 2009 i.e. Spouse, Child, Domestic Partner (Excel)
Educational Benefit, Qualified Dependents 2009i.e. Spouse, Child, Domestic Partner (pdf)
EEO/AA Appraisal (Institutional Equity)
Emergency Service Leave Request
Employee Award Request
Employee Personal Data Change Notice
Employee Recognition, (Appendix A)
Employment Interviewer Evaluation
Employment Separation Checklist
Employment Verification, I-9
Essential Position Request Form (Hiring Freeze)
| Evidence of Insurability |
|
RETURN TO:
Fort Dearborn Life Insurance Company, Attn: Membership
1020 31st Street
Downers Grove, IL 60515
|
Exit Interview Questionnaire
Express Scripts Mail Order (Must register to complete form)
Express Scripts Reimbursement
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F- Forms
Family Medical Leave Act (FMLA) Forms Overview
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): Eligibility Notice to Employer Under FMLA (OU FMLA #.03A)
Family Medical Leave Act (FMLA): Designation Notice Under FMLA(OU FMLA #.03B)
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 or Caregiver Leave for Injured or Ill Service Member) (OU FMLA #.05)
Family Medical Leave Act (FMLA): Certification of Bonding Leave Due to 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
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H-I- Forms
Homeland Security, DMA
I-9 Employment Verification
Incident Report (Workers Compensation)
Interim Base Wage Adjustment (Classified)
International Claim, Anthem BlueCard Worldwide®
Interview, Employment Evaluation
Interviewer Evaluation
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J- Forms
Job Information Questionnaire (JIQ) - Classified
Job Information Questionnaire (JIQ)- IT
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L- Forms
Leave of Absence (Classified employees)
Leave of Absence/Work Related Injury
Leave,Organ Donation
Leaves, Unpaid- Addendum for Administrative/Faculty Appointments
Life InsuranceBeneficiary
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M- Forms
Mail Order, Express Scripts (Must register to complete form)
Medical Claim, Anthem
Mid-Year Base Wage Adjustment (Classified)
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N- Forms
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O, P- Forms
Organ Donation Leave, Request for
Paid Time Off: Faculty and Staff (Excel)NEW!
Paid Time Off: Faculty and Staff (pdf) NEW!
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 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)NEW!
Personal Time: Administrators (pdf)NEW!
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 (Must register with Express Scripts to complete form)
Prescription Reimbursement, Express Scripts
Prior State Service Request for Transfer
Probationary Evaluation, Classified Non Bargaining
*May use either Performance Appraisal or PM1 form.
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R- Forms
Recognition, Employee (Appendix A)
Reliance Disability (Return to Human Resources)
Relocation Expense Repayment Agreement NEW!
Request for Organ Donation Leave
Resignation Form
Retirement Separation
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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)(NOT Required if using WorkForce system)
Sick Leave: Classified Employees (pdf) (NOT Required if using WorkForce system)
Sick Leave, Conversion
Sick Leave: Faculty and Staff (Excel) NEW!
Sick Leave: Faculty and Staff (pdf) NEW!
State Service, Prior (Request for Transfer)
Student Certification, Anthem
Supervisor Feedback PM3
Supervisor FeedbackPM3 (pdf)
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U- Forms
Unacceptable Behavior Incident Report
Unpaid Leaves- Addendum for Administrative/Faculty Appointment
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V- Forms
Vacation: Faculty and Staff (Paid Time Off) ExcelNEW!
Vacation: Faculty and Staff (Paid Time Off) pdfNEW!
Vision Claim (Anthem)(Faculty & Administrators)
VoluntaryFTE Reduction
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W- Forms
WageWorks, Flexible Spending Account- Dependent Care
WageWorks, Flexible Spending Account- Healthcare
Waiver of Group Health Insurance, Benefit
Workers Compensation, Incident Report
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