Human Resource Forms

DENTAL CARE

Retiree Enrollment Form - Over 65 (pdf)
Retiree Enrollment Form - Under 65 (pdf)

HEALTH CARE 

Waiver Forms/Retiree Enrollment:

Retiree Enrollment Form - Over 65 (pdf)
Retiree Enrollment Form - Under 65 (pdf)

Claim Forms:

Anthem Medical Claim (pdf)
Medical Claim Form for Claims Incurred Internationally (pdf)

NEW HIRE FORMS

Benefits:

Social Security Number Exception Request Form (pdf)

Employment:

Background Check Verification Process (Adobe web form)
Direct Deposit (Employee Self Service instructions) Note:  Employee Self Service will be accessible once you are notified by UDit that your UD account has been created.)
Employee Data Sheet Packet - Staff (Adobe web form)
Employee Data Sheet Packet - Faculty (Adobe web form)
Federal Withholding Instructions (W-4) (pdf)
Online Form I-9: Section 1 (The I-9 contains two separate sections referred to as Section 1 and Section 2. The cover page for Section 1 provides critical instructions - please review this page carefully. Please contact us at HR@udayton.edu with any questions). 
State of Ohio Withholding Certificate (IT4) (Adobe web form) - Employees working outside of Ohio, visit your state's revenue site to download and complete the appropriate State Withholding form.

* In addition to the above forms, Research Institute employees must also complete the following:

UDRI New Hire Forms (Adobe web form) 
Conflict of Interest Disclosure Form (pdf) Return completed form to supervisor

NON-EMPLOYEE FORMS

Visiting Scholar Application (tdx)
UDRI Visitor Technology Access Request (VTAR) (doc)

RETIREE or FORMER FACULTY/STAFF/GA PERSONAL DATA CHANGE 

Retiree or Former Faculty/Staff/GA Change in Personal Data (Adobe web form)