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 |
| Additional Benefits Enrollment Form |
| Applicant Flow Record |
| Authorization for Release of Protected Health Information |
| Beneficiary Change Form - Life Insurance and AD&D |
| Benefit Deduction Troubleshooting Form |
| 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 |
| 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 |
| CNA Retiree/Parent/Grandparent Enrollment Form |
| CNA Enrollment Form |
| Compensatory Time Agreement Form |
| Criminal Background Check Release Form |
| Dental Coverage Summary Plan Description |
| Discrimination Complaint Form |
| Formulario para Presentar una Demanda de Discriminacion |
| Exit Survey Packet |
| Employer's First Report of Injury or Illness Form
E1 Form 122 |
| FMLA - Certification of Health Care Provider |
| 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 Enrollment Form |
| FSA Reimbursement Request Form (ASI Flex)
For eligible expenses incurred for the last plan year July 1, 2006 through June 30, 2007 (and not yet reimbursed) or for the new plan year beginning July 01, 2007 |
| Health Care and Dental Coverage Enrollment Form |
| Health Care Coverage Change Form |
| 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 Plans Enrollment Form |
| 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 - CAMPUS |
| Life Insurance Enrollment Form - HOSPITAL |
| Long Term Care and AD&D Enrollment Form - Hospitals/Clinics |
| Long Term Disability Enrollment Form - Hospitals/Clinics |
| Long Term Disability - Hospitals/Clinics Physician Option Booklet |
| Long Term Disability Enrollment Form - SOM |
| Market Value Report Guidelines 2007 |
| Prescription Drug Coverage Information/Forms |
| Request for Non-Health Related Leave of Absence |
| New Position Classification Instructions |
| Non-selection Letter |
| Offer Letter |
| PAN - Personnel Action Notification Form
Note: When prompted, enter the job code to pull up the appropriate form |
| U Affiliate/POI Form
NED |
| 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. Contact: Katie Robertson, 581-3779 Fax: 585-3030 |
| Payroll - Academic Contract Worksheet |
| Payroll - Additional Compensation
Due by 5:00 PM, 3 Business Days Prior To Pay Period End. Contact: Holli Haurand, 581-3636 |
| Payroll - Additional Compensation for Teaching
Due By 5:00 PM, 3 Business Days Prior To Pay Period End. Contact: Holli Haurand, 581-3636 |
| Payroll - Bonus Pay Form
Due By 5:00 PM, Last Day of Pay Period. Contact: Jessica Brown, 585-9181 |
| Payroll - Clinical Income Payment
Due By 5:00 PM, Last Day of the Pay Period. Contact: Holli Haurand, 581-3636 |
| Payroll - Direct Deposit Cancellation Form
Due By 5:00 PM, Last Day of the Pay Period. Contact: Holli Haurand, 581-3636 |
| Payroll - Early Release Memo
Due By 12:00 Noon, 2 Business Days Before Payday. Contact: Front Desk, 581-7873 |
| Payroll - Early Retirement Incentive
Due By 5:00 PM, 3 Business Days Prior to Pay Period End. Contact: Holli Haurand, 581-3636 |
| Payroll - ERIP Auxiliary Earnings
Due By 5:00 PM, 3 Business Days Prior to Pay Period End. Contact: Holli Haurand, 581-3636 |
| Payroll - E&B Reprint
Call for Due Dates: Steve Thompson, 585-9199 |
| Payroll - Kronos Supervisor Access Request
Call for Due Dates: Holli Haurand, 581-3636 |
| Payroll - Kronos Late Signoff Form
Call for Due Dates: Jessica Brown, 585-9181 |
| Payroll - Missed Punch/Exception
Due By 5:00 PM, Last Day of the Pay Period. Contact: Your Departments Payroll Reporter |
| Payroll - Paper Timesheet(Campus Hourly)
Due By 12:00 Noon on Signoff Day. Contact: Jessica Brown, 585-9181 |
| Payroll - Faxed Timesheet Policy |
| Payroll - Paystub Copy Request or Self Service Online
Allow Up to 2 Days to Process. Contact: Front Desk, 581-7873 |
| Payroll - Prize and Awards
Due by 5:00 PM, Last Day of the Pay Period. Contact: Holli Haurand, 581-3636 |
| Payroll - Reallocations
Call for Due Dates. Contact: Steve Thompson, 585-9199 |
| Payroll - Stale Date Request
Call for Due Dates. Contact: Holli Haurand, 581-3636 |
| Payroll - Stop Payment
Call for Due Dates. Contact: Katie Robertson, 581-7873 |
| 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 |
| Request for Reinstatement of Prior Service |
| Request to Examine/Copy Data From Personnel File |
| 401(a) Retirement Plan Investment Provider Change Form |
| 401(a) Retirement Plan Waiver of Liability Form |
| Salary Reduction Agreement - 403(b) Supplemental Retirement Plan |
| Salary Reduction Agreement - 403(b) Roth Option |
| 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 Health Care Plus Advantage Plan |
| U Health Care Plus Basic Plan |
| U Health Care Plus Comprehensive Plan |
| ValueCare Advantage Plan |
| ValueCare Basic Plan |
| ValueCare Comprehensive Plan |
| Veteran's Preference Addendum, Utah State |
| Worldwide Assist Travel Assistance Brochure |
