A-Z Index | Forms

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Forms

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Browse forms: A | B | C | D | E | F | G | H | I | J | K | L | M | N |O | P | Q | R | S | T | U | V | W | X | Y | Z

A

ADA (Americans with Disabilities Act)

Essential and Marginal Job Functions Worksheet
Reasonable Accommodation Request and Documentation Form

Affidavit of Eligible Spouse/Child Status

Applicant Monitoring Form

Authorization Form for Motor Vehicle Records Check (Risk Management)

B

Background Check Consent Form

Beneficiary designation

Basic Life Insurance
Personal Accident Insurance
Supplemental Group Life Insurance

C

Claim forms

Dental expenses (CIGNA)

IU Health Center Claim Form (student health insurance only)

Medical expenses for all plans

Mental health expenses (IUPM) for PPO $900 Deductible

Prescription expenses (Wellpoint/NextRx) for all plans

TSB-HRA healthcare and dependent care expenses

Classification Appeal Form

D

Dental Claim Form (CIGNA)

Dependent Care Flexible Spending Account Worksheet (TSB)

Dependent child

Application/Affidavit to Establish Dependency by Guardianship

Certification of Disabled Dependent Child Eligibility

Certification of Eligibility for Dependent Child Age 19 or Older - 2009

Certification of Eligibility for Dependent Child Age 19 or Older - 2010

Domestic partnership

Affidavit of Domestic Partnership

Certification of Tax-Qualified Dependents

Same-Sex Domestic-Partner Health Plan Benefit Tax Estimation Work Sheet

Termination of Domestic Partnership

Bloomington campus only:
Drug Testing

Statement of Facts Supporting Reasonable Cause of Drug or Alcohol Use by Employee

Employee Authorization and Consent to Submit to Substance Abuse Testing

Employee Refusal to Submit To Substance Abuse Testing

Highlights of a Conditional Employment Agreement

Employer Authorization for Treatment/Testing - Except Workers Compensation
(Risk Management form)

 

E

Bloomington:
Employee Written Authorization for Release of Personnel File(s)

Service Maintenance positions Bloomington:
Employment Application Form | | RTF version
Work History Supplement

Essential and Marginal Job Functions Worksheet

F

Fee Courtesy (see Tuition Benefit)

Fidelity Investments

Fidelity IU Retirement Plan Enrollment and Beneficiary Designation Form
Plan # 57524

Fidelity IU Retirement Savings 457(b) Plan Enrollment and Beneficiary Designation Form
Plan # 71301

Fidelity IU TDA Plan Enrollment and Beneficiary Designation 403(b) Form
Plan # 51913

FMLA (Family and Medical Leave Act)

Certification of Qualifying Exigency for Military Family Leave

Certification for Serious Injury or Illness of Covered Service Member

FMLA Definition of Serious Health Conditions

FMLA Form 1 Leave Notice of Designation, Request, & Approval

Essential and Marginal Job Functions Worksheet

FMLA Form 2E Medical Certification for EMPLOYEE

FMLA Form 2F Medical Certification for FAMILY

FMLA Form 3 Intent to Return and Fitness for Duty/Medical Release

Medical Recertification Request

Tracking Sheet

Form I-9 and Instructions

G

Grievance forms

Hourly Employees

Professional and Non-union Support and Service Staff

Bloomington:
Service Maintenance Employees
Support Staff

H

Hourly positions at Bloomington

Employment Application | | RTF version

Education and Work History Supplement | | RTF version

Position Posting Request Form

I

I-9 Form and Instructions

IU Retirement Plan (see Retirement Plan, IU)

IU Retirement Savings Plan 457(b) (see Retirement Savings Plan, IU)

IUSERP

Investment Company Change Form

Fidelity Enrollment Form

TIAA-CREF IUSERP 401(a) GRA Enrollment Form
Plan ID 100266

IU Tax Deferred Annuity Plan (see Tax Deferred Account, IU)

IU Tuition Benefit (see Tuition Benefit, IU)

J

K

L

Leaves for Military Families Request Form |

Long-term Disability Insurance

Enrollment form |

Medical History Statement for Non-Indiana Residents

Medical History Statement for Residents of Indiana

M

Mass Transit Expense Claim form

Medical History Statement for Non-Indiana Residents

Medical History Statement for Residents of Indiana

Medical Savings Contribution Change Form (IU HDHP PPO & Medical Savings Plan)

Mid-Year Salary Adjustment Form for Professional Staff

Standard form

Form to use with 5 or more funding sources

Motor Vehicle Records Check -- Authorization Form (Risk Management)

N

O

P

PERF Change Beneficiary

PERF Change of Name or Address

PERF Investment Direction

PERF Request for Estimate of Benefits

Personal Accident Insurance (PAI)

Beneficiary Designation

Enrollment form

Personal Profile Forms

Change Form, Personal Data

Personal Profile Form (ED)

Personal Profile Form (PS)

Personal Profile Form (PSA)

Bloomington:
Personnel File(s), Employee Written Authorization for Release

Position Description

Position Requisition and Guidelines

Prescription Expenses Claim for (Wellpoint/NextRx)

Prescription Mail Order Form (Anthem) for PPO $900 Deductible and Blue Preferred Primary POS

Q

R

Reasonable Accommodation Request and Documentation Form

Recognition Plan Document

Retiree Health Care Enrollment Form (under age 65)

Retirement Plan, IU

Investment Company Change Form

Fidelity IU Retirement Plan Enrollment and Beneficiary Designation Form
Plan # 57524

TIAA-CREF IU Retirement Plan 403(b) RA Enrollment Form
Plan ID 100265

Retirement Savings Plan 457(b), IU

Salary Deferral Agreement Form

Fidelity IU Retirement Savings 457(b) Plan Enrollment and Beneficiary Designation Form
Plan # 71301

TIAA-CREF IU Retirement Savings Plan 457(b) GSRA Enrollment Form
Plan ID 100268

Reward Plan Document

S

Salary

Mid-Year Salary Adjustment Form for Professional Staff

Standard form

Form to use with 5 or more funding sources

Separating Employment from IU

Employee Checklist

Supervisor Checklist

Service Maintenance positions Bloomington

Employment Application | | RTF version

Work History Supplement

 

Bloomington:
Staff Report (For long documents)

Staff Report (For short documents; requires Adobe Reader 7.0.)

Bloomington:
Staff Position Posting Request Form

Student health insurance

International Dependent Enrollment Form 2008-09

International Continuation Form - Fall 2008

International/SAA Temporary ID card

IU Health Center Claim Form

SAA/Fellowship Dependent Enrollment Form 2008-09

SAA/Fellowship Continuation Form - Fall 2008

Undergraduate and Graduate Voluntary Enrollment Form (Student Health Insurance)

Visiting Scholars and Dependents Enrollment Form 2008-09

Supplemental Life Insurance

Beneficiary Designation

Enrollment Form |

Medical History Statement for Non-Indiana Residents

Medical History Statement for Residents of Indiana

T

Tax Deferred Account (TDA) 403(b), IU (formerly IU Tax Deferred Annuity Plan)

Salary Deferral Agreement

Fidelity IU TDA Plan Enrollment and Beneficiary Designation 403(b) Form
Plan # 51913

TIAA-CREF IU TDA 403(b) GSRA Enrollment Form
Plan ID 100267

Tax Saver Benefit (TSB) Plan

Claim form for expenses (TSB & HRA)

Dependent Care Flexible Spending Account Worksheet (TSB)

Direct Deposit Authorization/Termination form (TSB & HRA)

* See the Benefits Change Connection about making changes to your plan

Bloomington:
Telephone Reference Check

TIAA-CREF

IU Retirement Plan 403(b) RA Enrollment Form
Plan ID 100265

IU Retirement Savings Plan 457(b) GSRA Enrollment Form
Plan ID 100268

IUSERP 401(a) GRA Enrollment Form
Plan ID 100266

IU TDA 403(b) GSRA Enrollment Form
Plan ID 100267

Timesheets

PAE (Exempt) Staff PTO Record Card

Tobacco-free HRA

Claim form for expenses (TSB & HRA)

Direct Deposit Authorization/Termination form (TSB & HRA)

Tuition Benefit (formerly Fee Courtesy)

2009-2010 IU Tuition Benefit Enrollment Form |

2008-2009 IU Tuition Benefit Enrollment Form

IUHS Tuition Waiver Form |

U

Service Maintenance positions Bloomington:
Unsafe Working Conditions |

V

W

Service Maintenance positions Bloomington:
Work History Supplement

X

Y

Z