Human Resources » Forms Library

Faculty & Staff, please print the appropriate form(s), fill it out and submit it to the Human Resources Department.

• For Benefit Purposes:
  • Adoption Reimbursement Request
  • Agreement For Salary Reduction Under Section 403(b)
  • Authorization For Payroll Deductions
  • Authorization To Release Protected Health Information
  • Educational Assistance Application
  • Employee X-Ray Referral
  • General Notice Of COBRA Continuation Coverage Rights
  • Health Savings Plan and Flexible Spending Account Claim for Reimbursement
  • Notice Of Privacy Practices
  • Personal Representative Designation/Authorization
  • Request For Amendment Of PHI
  • Request For Confidential Communications
  • Request To Access Own PHI
  • Request To Inspect Or Copy PHI
  • Request To Restrict Certain Uses & Disclosures
  • Time Off Request
  • Tuition Remission Application
• For Payroll Purposes:
  • Direct Deposit Authorization (.doc)
  • Employee Time Sheet (.xls)
  • Form 8233 2001
  • Professional/Faculty PTO Report (.xls)
• For Other Purposes:
  • Accident/Injury Report
  • ADA Request For Accommodation
  • Employee Address Change
  • Employee Emergency Contact Data
  • Employee Key Request
  • Internal Job Opportunity Application
  • Incident Report

If the form(s) that you need cannot be found in the above, please obtain the appropriate form(s) from the HR Department, fill it out and submit it back to the HR Department.

• For Benefit Purposes:
  • America's VEBA Solution - Authorization Agreement For Direct Deposit
  • America's VEBA Solution - Dependent Care Worksheet
  • America's VEBA Solution - Employee Flexible Benefit Cafeteria Plan Program Election/Change
  • America's VEBA Solution - Medical Expense Reimbursement Plan Worksheet
  • America's VEBA Solution - VEBA Health Savings Plan & Flexible Spending Account Claim For Reimbursement
  • Formula Dental - Enrollment & Change
  • Group Coverage Change
  • Beneficiary Change
  • Certificate of Insurance Portability
  • Northwestern Clinical Laboratory - Lab Request
  • New Provider And/Or Clinic Site Information
  • Pre-Paid Legal Services, Inc. - Universal Membership Application
• For Recruiting Employees Purposes:
  • Applicant Tracking Record
  • Application For Employment
  • Employment Eligibility Verification - Form I-9
• For Other Purposes:
  • Employee Council Employee Emergency Fund Request
  • Employee Status Change
  • Employee Suggestion
  • Minnesota Department Of Revenue - Reciprocity Exemption/Affidavit of Residency
  • Residency Application
  • Tell Us About Yourself

If you are not sure which form(s) that you should use to meet your needs, please contact any one of our Human Resources Staff.