Human Resources Forms
Forms listed below are grouped by department and listed in alphabetical order by title. Some forms require Adobe Acrobat Reader for viewing. Acrobat Reader is available free of charge from Adobe Systems.
Benefits | Absence Management | Payroll | Employment Services | Compensation | Employee Relations | Immunization
Benefits
UBenefits Electronic Enrollment and Changes
- UBenefits
- New Hire Enrollment
- Add a Child
- Add a Spouse/Partner
- Beneficiary Update
- Cancel Disability, AD&D or Life Insurance
- Change AD&D Coverage
- FSA Dependent Care Change
- Gain of Other Coverage
- HSA Pledge Change
- Loss of Other Coverage
- Remove a Spouse/Partner
- Salary Reduction Agreement - 403(b) Supplemental Retirement Plan
- Salary Reduction Agreement - 457(b) Supplemental Retirement Plan
- 401(a) Provider Change and Salary Reduction Agreements
- Tuition Reduction Application
Medical/Dental Forms
- Advantage Plan Summary Plan Description
- Authorization for Release of Protected Health Information
- Certification of Dual Coverage for Coordination of Prescription Benefits
- COBRA Notice
- Comprehensive Plan Summary Plan Description
- Consumer Directed Health Plan Summary Plan Description
- Dental Coverage Summary Plan Description
- Health Care Student Verification
- Health Insurance Marketplace Notice
- Health Plan Request for Reimbursement - Blue Cross Blue Shield/ValueCare
- Health Plan Request for Reimbursement - University Health Care Plus
- Notices - HIPAA Opt Out and CHIP
- Prescription Drug Coverage Information/Forms
- Privacy Notice
- Medicare D Notice of Creditable Coverage
- Summary Comparison of Health Plan Medical and Dental Options
- Submit Family Member Tax Identification Number
Flexible Spending Forms
- Parking FSA Election/Change Form
- Parking Reimbursement Request Form
- Flexible spending account change form
Life & Disability Forms
- Additional Benefits Enrollment
- Life Insurance - Personal Health Application
- Long Term Disability - Late Enrollment (paper form)
- Long Term Disability - Late Enrollment (online form) - Policy 136485
Retirement Forms
- Certification of Hardship Withdrawal from Employer 401(a) Contributions (Employee must be age 59½ or older)
- Certification of Hardship Withdrawal from Elective 403(b) Contributions
- Certification of Hardship Withdrawal from Elective 457(b) Contributions
- University's Annual Universal Availability Notice
Other Forms
- ACH Agreement
- Benefits Billing
- Domestic Partnership Certification
- Employer's First Report of Injury or Illness (Worker's Comp) - E1 Form 122
- Extended Sick Leave Benefits
- MetLife Legal Plans Certificate of Coverage
- LTC - CNA Enrollment
- Preventive Services Under ACA
- Reinstatement of Prior Service
- Request for Reinstatement of Lost Vacation Accruals
- Separating from the University
- Travel Assistance Brochure - Life Insurance
- Travel Assistance Brochure - Life Insurance (Spanish)
- Vacation Donation
- WellU Request for an Alternative Option.
Absence Management
- Employer's First Report of Injury or Illness (Worker's Comp) - E1 Form 122
- FMLA - Certification of Health Care Provider for Employee
- Certifcacion de Proveedor Medico Estado de Salud del Empleado
- FMLA - Certification of Health Care Provider for Dependent
- Certifcacion de Proveedor Medico Estado de Salud del Familiar
- FMLA - Frequently Asked Questions
- FMLA - FAQs en espano
- FMLA - Intermittent Tracking
- Intermittent_Parental Tracking Form
- FMLA and Parental Leave Request
- Solicitud para FMLA y Ausencia Paternal - Maternidad, Paternidad y Adopcion
- FMLA - Release of Information (Family Member)
- FMLA - Release of Information (Self)
- FMLA - Request for Family and Medical Leave of Absence
- Solicitud Para Ausencia bajo la Ley de Ausencia Familiar y Medica
- Military Leave of Absence
- Request for Non-Health Related Leave of Absence
Payroll
- Academic Contract Worksheet
- Accruals Adjustments, Vacation
- Cell Phone Reimbursement
- Direct Deposit Help
- Direct Deposit Cancellation
- Missed Punch/Exception
- Paper Timesheet
- Retroactive Adjustment (Hospital)
- Reallocations
- Stale Date Request
- Stop Payment
Kronos
- Kronos Supervisor Access Request
- Kronos Late Sign off
- Kronos Senior Administration Accrual Tracking Request
Additional Earnings
- Additional Compensation
- Additional Compensation for Teaching
- Bonus Pay
- Clinical Income Payment
- Moving Allowance
- Payment of Exempt Clinical Shift
- Prize and Awards
Employment Services
- Affiliate/Non-Employee
- Company Consulting Services Agreement
- Initiate Background Check and/or Drug Screen
- Initiate Drug Screen Only
- I-9 Appointment Request Form (traditional HR only)
- Certiphi Background Check / Drug Screen Information Letter
- Confidentiality and Information Security Agreement
- Employee Intellectual Property Assignment Agreement
- Employees Return To Campus
- Employment Verification Request (Grants and Contracts only)
- Employment Verification Request (Past and Present employee use only)
- Email I-9 Team
- ePAF/D-Jobs/HRIL Security Authorization Form
- Hiring Process & Forms/Open Position Information
- Hiring Status Planning form
- IRS Forms and Instructions
- Non-selection Letter
- Non-Staff and Volunteer Photo ID Authorization
- Non-Staff Workforce & Volunteer ID Badge Information Data Sheet
- Offer Letter, Benefited Staff
- Offer Letter, Non-Benefited Staff
- Out of State Employment Request
- Reference Check, Sample Document
- Telecommuting Plan and Agreement Form
- UUHealth Benefitted Offer Letter
- UUHealth NonBenefitted Offer Letter
- Veterans' Preference Addendum
- Working outside Utah or United States
- Workplace Drug and Alcohol Testing Program for Commercial Drivers
Compensation
- Compensatory Time Agreement
- Leadworker Employee Questionnaire
- Lump Sum Increase
- Compensation Request Form
- Reclassification Instructions
Employee Relations
Immunization
Workplace Accommodations
- ADA Accommodation Request
- Pregnancy Accommodations Request
- Religious Accommodation Request
- Vaccine Exemption Request