Absence Reports/Timesheets
- Absence Report for Classified Employees BS-59
- Absence Report for Certificated Employees BS-137
- Classified Employees Differential and Overtime Timesheet BS-139
- Student Help Timesheet BS-91
- Temporary Classified Timesheet BS-68
Adjunct Insurance Forms
Domestic Partner Forms
HSA/FSA Forms
Flexible Spending Accounts (FSA)
- Basic CDA – Dependent Care Eligible Expenses
- Basic CDA – Dependent Care Contract
- Basic CDA – MyCash Account
- Basic CDA – FSA Participant Enrollment Guide
- Basic CDA – Direct Deposit Request
- Basic CDA – Reimbursement Request
- Basic CDA – Participant Reference Guide
- Basic CDA – Participant Experience Flyer
- Basic CDA – Medical FSA Election Worksheet
- Basic CDA – Orthodontia Contract
Leave Forms
Catastrophic Leave
Classified Staff
- Application for Catastrophic Leave for Classified and Management Employees BS-185
- Catastrophic Leave Medical Certification BS-184
Certificated Staff
- Extended Catastrophic Leave Application for Faculty BS-200
- Authorization for Release of Faculty Medical Information
- Extended Catastrophic Leave Medical Certification for Faculty BS-201
Five Month Law
- Five Month Law Physician's Verification
- Verification of Illness Form – Not for use for Five Month Law or Catastrophic Leave
Family Medical Leave Act (FMLA)
- FMLA Request BS-186
- Certification of Health Care Provider for Employee's Serious Health Condition WH-380-E
- Certification of Health Care Provider for Family Member's Serious Health Condition WH-380-F
Parental Leave
Certificated Only
- Parental Leave of Absence for Birthing Parent (LRCFT)
- Parental Leave of Absence for Non-Birthing Parent (LRCFT)
General
Sick Leave and Vacation Forms
Long-Term Care Insurance Forms
Class 001 – Classified Staff Working at Least 20 Hours Per Week
- Class 001 Long-Term Care Enrollment
- UNUM Checklist of Delivered Forms
- Long-Term Care Medical Questionnaire
- Request to Change Long-Term Care Coverage
- Election to Continue Long-Term Care Coverage
Class 002 – Certificated Staff Working at Least 50%
- Class 002 Long-Term Care Enrollment
- UNUM Checklist of Delivered Forms
- Long-Term Care Medical Questionnaire
- Request to Change Long-Term Care Coverage
- Election to Continue Long-Term Care Coverage
Class 003 – Adjunct/Permanent Part-Time Staff (Not Qualified for Class 001 or 002)
- Class 003 Long-Term Care Enrollment
- UNUM Checklist of Delivered Forms
- Long-Term Care Medical Questionnaire
- Request to Change Long-Term Care Coverage
- Election to Continue Long-Term Care Coverage
New Hire Forms
Retirement Savings Plan Forms
403B Savings Plan
457 Savings Plans
Retirement Savings Distributions
Questions?
Contact Employee Benefits for more information.