Forms listed below are sorted in alphabetical order by title and may require Adobe Acrobat Reader for viewing. Acrobat
Reader is available free of charge from Adobe Systems.
 | Acceptance of Resignation |
| AD&D Enrollment Form - Hospitals/Clinics |
| Additional Benefits Enrollment Form |
| Applicant Flow Record |
| Authorization for Release of Protected Health Information |
| Beneficiary Change Form - Life Insurance and AD&D |
| Benefit Cancellation Request |
| Benefits Enrollment Information |
| BlueCross BlueShield Advantage Plan |
| BlueCross BlueShield Basic Plan |
| BlueCross BlueShield Comprehensive Plan |
| BlueCross BlueShield Medical Claim Form |
| Cell Phone Allowance Form |
| Cell Phone - Policy (Hospital) |
| Cell Phone Cancellation Form |
| Certification of Dual Coverage for Coordination of Prescription Benefits |
| Certification of Hardship Withdrawal from Elective 403(b) Contributions |
| Certification of Hardship Withdrawal from Elective 457(b) Contributions |
| Charge Nurse Kronos Access Request Form |
| Coordination of Prescription Benefits Claim Form |
| Compensatory Time Agreement Form |
| Complete list of Information Technology jobs and descriptions |
| Dental Coverage Summary Plan Description |
| Discrimination Complaint Form |
| Drug Screening - Schedule a pre-employment drug screening |
| Formulario para Presentar una Demanda de Discriminacion |
| eduCAT Reporter Request Form |
| Exit Survey Packet |
| Employer's First Report of Injury or Illness Form
E1 Form 122 |
| FMLA - Certification of Health Care Provider for Employee |
| FMLA - Certification of Health Care Provider for Dependent |
| FMLA - Frequently Asked Questions |
| FMLA - Intermittent Tracking Form |
| FMLA - Release of Information (Family Member) |
| FMLA - Release of Information (Self) |
| FMLA - Request for Family and Medical Leave of Absence |
| FSA Change Form |
| FSA Enrollment Form |
| FSA Renrollment Form |
| FSA Reimbursement Request Form (ASI Flex) |
| Health Care and Dental Coverage Enrollment Form |
| Health Care Coverage Change Form |
| Health Plan Request for Reimbursement - Blue Cross Blue Shield/ValueCare |
| Health Plan Request for Reimbursement - University Health Care Plus |
| Hiring Process & Forms/Open Position Information |
| Immunization Form
University Hospital Staff Only |
| I-9 Employment Verification Form |
| Form I-9 Guidelines |
| Temporary Visa Overview |
| Hyatt Legal Plans Certificate of Coverage |
| Hyatt Legal Plan Covered Legal Services |
| Hyatt Legal Plan Information |
| Hyatt Legal Plan Form - New Hires |
| Hyatt Legal Plan Participating Utah Attorneys |
| IRS Forms and Instructions |
| Job Analysis Questionnaire |
| Job Analysis Questionnaire-Supervisor Review |
| Leadworker Employee Questionnaire |
| Life Insurance - Personal Health Application |
| Life Insurance Enrollment |
| Long Term Disability Enrollment Form - Hospitals/Clinics |
| Long Term Disability - Hospitals/Clinics Physician Option Booklet |
| Long Term Disability Enrollment Form - SOM |
| Long Term Disability - Late Enrollment Form |
| LTC - CNA Employee/Spouse Enrollment Form - Short Form |
| LTC - CNA Enrollment Form |
| LTC - CNA Retiree/Parent/Grandparent Enrollment Form - Long Form |
| Market Value Report Guidelines 2007 |
| Prescription Drug Coverage Information/Forms |
| New Position Classification Instructions |
| Non-selection Letter |
| Non-Staff and Volunteer
Photo ID Authorization Form |
| Non-Staff Workforce & Volunteer ID Badge
Information Data Sheet
|
| Offer Letter |
| HRIS - Information Request Form (internal use only) |
| Payroll - Guidelines (Hospital) |
| Payroll - Retroactive Adjustment Form (Hospital) |
| Payroll - Premium Holiday Hours and OT Compensation (Hospital) |
| Payroll - Special Check Form (Hospital) |
| Payroll - Accruals Adjustments, Vacation
Due by the Last Day of Each Pay Period. |
| Payroll - Academic Contract Worksheet |
| Payroll - Additional Compensation
Due by 5:00 PM, 3 Business Days Prior To Pay Period End. |
| Payroll - Additional Compensation for Teaching
Due By 5:00 PM, 3 Business Days Prior To Pay Period End. |
| Payroll - Bonus Pay Form
Due By 12:00 PM, Last Day of Pay Period. |
| Payroll - Clinical Income Payment
Due By 5:00 PM, Last Day of the Pay Period. |
| Payroll - Direct Deposit Authorization Form
Due By 5:00 PM, Last Day of the Pay Period. |
| Payroll - Direct Deposit Cancellation Form
Due By 5:00 PM, Last Day of the Pay Period. |
| Payroll - Early Release Memo
Due By 12:00 Noon, 2 Business Days Before Payday. |
| Payroll - Early Retirement Incentive
Due By 5:00 PM, 3 Business Days Prior to Pay Period End. |
| Payroll - ERIP Auxiliary Earnings
Due By 5:00 PM, 3 Business Days Prior to Pay Period End. |
| Payroll - E&B Reprint |
| Payroll - Kronos Supervisor Access Request |
| Payroll - Kronos Late Signoff Form |
| Payroll - Missed Punch/Exception
Due By 5:00 PM, Last Day of the Pay Period. |
| Payroll - Paper Timesheet(Campus Hourly)
Due By 12:00 Noon on Signoff Day. |
| Payroll - Payment of Exempt Clinical Shift |
| Payroll - Faxed Timesheet Policy |
| Payroll - Paystub Copy Request or Self Service Online
Allow Up to 2 Days to Process. |
| Payroll - Prize and Awards
Due by 5:00 PM, Last Day of the Pay Period. |
| Payroll - Reallocations
Call for Due Dates. |
| Payroll - Stale Date Request
Call for Due Dates. |
| Payroll - Stop Payment
Call for Due Dates. |
| Position Requisition Form
Online Version |
| Position Requisition Form
PDF Version |
| Reclassification Instructions |
| Reference Check, Sample Document |
| Request for Military Leave of Absence |
| Request for Courtesy Posting–Temporary Position |
| Request for Disability Accommodation Form |
| Formulario para Solicitar un Acomodo de Discapacidad |
| Request for Extended Sick Leave Benefits |
| Reguest for Non-Health Related Leave of Absence Form |
| Request for Reinstatement of Prior Service |
| Request to Examine/Copy Data From Personnel File |
| 401(a) Retirement Plan Investment Provider Change Form |
| Salary Reduction Agreement - 403(b) Supplemental Retirement Plan |
| Salary Reduction Agreement - 457(b) Supplemental Retirement Plan |
| Separating from the University |
| Staff Grievance Form |
| Statement of Proficiency |
| Summary Comparison of Health Plan Medical and Dental Options |
| Tax Forms |
| Travel Assistance Brochure (ADA) |
| Tuition Reduction, Application for |
| UUHSC Security and Confidentiality Agreement |
| U Affiliate/Non Employee Form
NED |
| U Health Care Plus Advantage Plan |
| U Health Care Plus Basic Plan |
| U Health Care Plus Comprehensive Plan |
| Vacation Donation Form |
| ValueCare Advantage Plan |
| ValueCare Basic Plan |
| ValueCare Comprehensive Plan |
| Veteran's Preference Addendum, Utah State |
| Worldwide Assist Travel Assistance Brochure |
