Forms

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Benefits Forms
1)	Carrier Change Form
2)	Change of Name/Address Notification
3)	College Release Program and Staff Education Reimbursement Request
4)	Family Medical Leave/Parental Leave Request
5)	FMLA Certification of Health Care Provider for Employee
6)	FMLA Certification of Health Care Provider for Family Member
7)	FMLA Certification of Qualifying Exigency for Military Family Leave
8)	FMLA Certification for Serious Injury of Covered Servicemember - Caregiver Leave
9)	Fitness Release Time Application
10)	Optional Retirement Plan Termination Notice
11)	Optional Retirement Program Certification
12)	Salary Reduction Agreement (ORP & TDA)
13)	Sick Leave Pool Contribution/Withdrawal Request
14)	Termination / Transfer-Clearance Form
15)	The Edge (Staff Council Form)

Claim Forms
1)	Fort Dearborn Accelerated Life Claim Form
2)	Fort Dearborn Disability Claim Form
3)	Fort Dearborn Dismemberment Claim Form
4)	Fort Dearborn Extended Life Claim Form
5)	Health Select Claim Form
6)	Pay Flex Claim Form

Workers' Compensation Forms
1)	Authorization for Release of Information (SORM-16)
2)	Employee's Election Regarding Utilization of Sick and Annual Leave (SORM-80)
3)	Employer's First Report of Injury or Illness (DWS-1S)
4)	Employee's Report of Injury (SORM-29)
5)	Witness Statement (SORM-74)

EEO Forms
1)	Veterans Status Questionnaire

Employment Forms
1)	Consulting and Outside Employment (for faculty and staff working a second job)
2)	Voluntary Modification of Employment Agreement
3)	Employee Data Sheet
4)	Employment Authorization Request
5)	Exit Interview Questionnaire
6)	Fair Credit Reporting Act
7)	Internal Employment Request Form
8)	Interview Request for Faculty Candidate
9)	Interview Request for Professional Staff Candidate
10)	Job Offer Request Form
11)	Motor Vehicle Record Evaluation Request
12)	New Employee Orientation Survey
13)	Notice of Terms of Initial Appointment
14)	Personnel Recommendation
15)	Position Announcement
16)	Required Documents for New Employees
17)	Security Sensitive Position Questionnaire
18)	Strategies for Orientation Success (SOS)
19)	Student Assistant Job Announcement Form
20)	Student Worker Statement of FERPA Understanding
21)	Supplemental Request to Fill a Position

Payroll Forms
1)	Advance Authorization for Overtime
2)	Application for Leave
3)	Direct Deposit Authorization
4)	Moving and Relocation Expense Form
5)	Pay Option Form
6)	Time and Effort Adjustment Request
7)	Timesheet - Biweekly
8)	W4

Compensation/Performance Management Forms
1)	eAppraisal End-User Manual
2)	Job Analysis Questionnaire (JAQ)

Progressive Disciplinary Forms
1)	Notice of Verbal Counseling

Prior approval from ESO is required for forms # 2 through # 5
2)	Employee Written Reprimand
3)	Notice of Suspension Without Pay
4)	Notice of Dismissal from Employment
5)	Performance Improvement Plan (PIP)

General Forms
1)	Communication Stipend Request
2)	Business Use Only Verification
3)	Media Release Form

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Last updated or reviewed on 3/22/12