Human Resource Forms
- Adoption Reimbursement
- Continuing Education
- Dental Care
- Emergency Loan Application
- Flexible Spending
- Health Care
- Life Insurance
- New Hire Forms
- Non-Employee Forms
- Outside Employment & Additional Services
- Personal Data Change Form
- Position Classification Justification Forms
- Promotion Review Form
- Separation Forms
- Tuition Exchange
- Vision Plan
Adoption Reimbursement Form (doc)
CONTINUING EDUCATION FUNDS - Center for Leadership
Center for Leadership Programs
Executive Program Form (pdf)
Retiree Enrollment Form - Over 65 (pdf)
Retiree Enrollment Form - Under 65 (pdf)
Emergency Loan Application (pdf)
Direct Deposit Enrollment Form (pdf)
Medical & Dependent Care Claim Form (pdf)
Orthodontic Claim Form (pdf)
Waiver Forms/Retiree Enrollment:
Affidavit of Spousal Eligibility for Health Care (pdf)
Affidavit of Non-Tobacco Use (pdf)
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)
The Hartford Evidence of Insurability Form (pdf)
The Hartford Beneficiary Designation Form (pdf)
Benefits:
Social Security Number Exception Request Form (pdf)
MyCafeteria Plan Direct Deposit Form (pdf)
TIAA New Hire Flyer (pdf)
Background Check Verification Process
Direct Deposit Form (pdf)
Employee Data Sheet Packet - Staff (pdf)
Employee Data Sheet Packet - Faculty (pdf)
Federal Withholding Instructions (W-4) (pdf)
Instructions for Completing the Electronic I-9 (Employment Eligibility Verification) (pdf)
**To schedule an appointment to complete an I-9, you may use the following online calendar tools or call our office at 937-229-2541 for an appointment.
Online I-9 Google Calendar Link - Instructions to create I-9 appointment (pdf)
I-9 Appointment Request Form (for those without a google account)
State of Ohio Withholding Certificate (IT4) (pdf) - 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 (pdf)
Conflict of Interest Disclosure Form (pdf) Return completed form to supervisor
Background Verification
Non-Employee Agreement & Information Sheet
Visitor Personnel Action Form (PAF) (xls)
Visitor Technology Access Request (pdf) - applicable to UDRI non-employees only
OUTSIDE EMPLOYMENT & ADDITIONAL SERVICES
Outside Employment & Additional Services Approval Form (pdf)
Request for Change of Personal Data Form (pdf)
POSITION CLASSIFICATION JUSTIFICATION
Position Classification Justification Form (doc)
Position Description Guidelines (pdf)
Promotion Review Form (pdf)
Employee Separation Checklist (pdf)
Fifth Third HSA Post-Separation Fee Structure (pdf)
Separation Q&A (pdf)
Supervisor Separation Checklist (pdf)
Voluntary Resignation Form (tdx)
Tuition Exchange Application (pdf)
Tuition Assistance Application for Child or Spouse (pdf)
EyeMed Out-of-Network Claim Form (pdf)
EyeMed Provider Nomination Form (pdf)