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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 Word 2007
Reasonable Accommodation Request and Documentation Form PDF

Affidavit of Eligible Spouse/Child Status pdf icon

Application for IU Employment (Service Maintenance and Temporary)
see Employment Application

Approval Form for a Leave for Development of Commercial Projects with a Non-University Entity pdf icon

Authorization Form for Motor Vehicle Records Check (Office of Insurance, Loss Control & Claims) pdf icon

B

Background Check Consent Form pdf icon

Beneficiary designation

Basic Life Insurancepdf icon
Personal Accident Insurancepdf icon
Supplemental Group Life Insurancepdf icon

C

Claim forms

Anthem Medical Claim Form (HDHP PPO, PPO $900, & PPO $400 plans) pdf icon

CIGNA Dental Claim Form pdf icon

HealthSmart Medical Claim Form (IUHQP plan) pdf icon

IU Health Center Claim Form pdf icon(student health insurance only)

Prescription Drug Claim Form for all plans pdf icon

TSB Healthcare and Dependent Care Claim form pdf icon

Classification Appeal Form (see Request for Reconsideration of Position Classification)

Commercial Leaves form (see Approval Form for a Leave …)

Commuting Expense Claim Formpdf icon

D

Dental Claim Form (CIGNA) pdf icon

Dependent Care Flexible Spending Account Worksheet (TSB)pdf icon

Dependent child

Application/Affidavit to Establish Dependency by Guardianship pdf icon

Certification of Disabled Dependent Child Eligibility pdf icon

Domestic partnership

Affidavit of Domestic Partnership pdf icon

Certification of Tax-Qualified Dependents pdf icon

Same-Sex Domestic-Partner Health Plan Benefit Tax Estimation Work Sheet
   - 2013pdf icon
   - 2014pdf icon

Termination of Domestic Partnership pdf icon

Termination of Tax-Qualified Dependent Status pdf icon

Drug Testing

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

Employee Authorization and Consent to Submit to Substance Abuse Testing PDF

Employee Refusal to Submit To Substance Abuse Testing PDF

Highlights of a Conditional Employment Agreement PDF

Request for Alcohol/Drug Screening (campus-specific form and procedures at Office of Insurance, Loss Control & Claims site)online

 

E

Employee Recognition Award Planpdf icon

Employee Referral Incentive Validation Form pdf icon

Employee Written Authorization for Release of Personnel File(s)pdf icon

Employment Application (Service Maintenance and Temporary)

Application fillable PDF | HTML| RTF
Background Check Consent Statement fillable PDF
Work History Supplement pdf icon

Essential and Marginal Job Functions Worksheet Word 2007

F

Family Status Change online form

Fee Courtesy (see Tuition Benefit)

 

FMLA (Family and Medical Leave Act)

Certification of Qualifying Exigency for Military Family Leave pdf icon

Certification for Serious Injury or Illness of Covered Service Member pdf icon

FMLA Definition of Serious Health Conditions PDF

FMLA Form 1 Leave Notice of Designation, Request, & Approvalpdf icon

Essential and Marginal Job Functions Worksheet Word 2007

FMLA Form 2E Medical Certification for EMPLOYEE pdf icon

FMLA Form 2F Medical Certification for FAMILY pdf icon

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

Medical Recertification Request pdf icon

Tracking Sheet pdf icon

Form I-9 pdf iconand Instructions

G

Grievance forms

Professional and Non-union Support and Service Staff PDF
Temporary Employees PDF

Bloomington and Northwest:
      Support Staff PDF

Bloomington, IUPUI, and South Bend:
      Service Employees PDF

Bloomington, IUPUI, Northwest, South Bend, and Southeast:
      Police Service Employees PDF

H

Health Savings Contribution Change Form PDF form

I

I-9 Form pdf icon and Instructions

Incentive Pay or Commission Plan pdf icon

IU Tuition Benefit (see Tuition Benefit, IU)

J

K

L

Long-term Disability Insurance

Claim Packet pdf icon

Enrollment formglobe icon | pdf icon

Medical History Statement for Non-Indiana Residents pdf icon

Medical History Statement for Residents of Indiana pdf icon

M

Mass Transit Expense Claim form (see Commuting Expense Claim Form)

Medco Rx forms (see Prescription Drug forms)

Medical claim forms (see Claim forms)

Medical History Statement for Indiana Residents pdf icon

Medical History Statement for Non-Indiana Residents pdf icon

Military

Leaves for Military Families Request Form globe icon | pdf icon

Verification of Military Service or Training This form is a PDF

Motor Vehicle Records Check -- Authorization Form (Office of Insurance, Loss Control & Claims) pdf icon

N

O

P

PERF Change of Address PDF

PERF Change of Beneficiary PDF

PERF Change of Name PDF

Personal Accident Insurance (PAI)

Beneficiary Designation pdf icon

Enrollment form globe icon

Personal Profile Forms

Change Form, Personal Datapdf icon

Personal Profile Form (ED) pdf icon

Personal Profile Form (PS) pdf icon

Personal Profile Form (PSA) pdf icon

Personnel File(s), Employee Written Authorization for Releasepdf icon

Position Description Formglobe icon

Prescription Drug Claim Form pdf icon

Prescription Drug Mail Order Form pdf icon

Prescription Drug Refill Request Form pdf icon

Q

R

Reasonable Accommodation Request and Documentation Form PDF

Request for Reconsideration of Position Classification Word

S

Separating Employment from IU

Employee Checklist pdf icon

Supervisor Checklist pdf icon

Service Maintenance positions employment application (see Employment Application)

Bloomington:
Staff Report Word (For long documents)

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

Bloomington:
Staff Position Posting Request Form globe icon (goes to University OLA staff side)

Student health insurance

IU Health Center Claim Form pdf icon

See the Student Health Insurance web pages for forms specific to each plan

Supplemental Life Insurance

Beneficiary Designationpdf icon

Enrollment Formglobe icon | pdf icon

Medical History Statement for Non-Indiana Residents pdf icon

Medical History Statement for Residents of Indiana pdf icon

T

Tax Saver Benefit (TSB) Plan

TSB Healthcare and Dependent Care Claim form pdf icon

Dependent Care Flexible Spending Account Worksheet (TSB) pdf icon

Direct Deposit Authorization/Termination form (TSB) pdf icon

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

Bloomington:
Telephone Reference Check pdf icon

Tuition Benefit (formerly Fee Courtesy)

2012-2013 IU Tuition Benefit Enrollment Form globe icon

2012-2013 & 2013-2014 IU Tuition Benefit Enrollment Formpdf

IUHS Tuition Waiver Form globe icon | pdf icon

U

Service Maintenance positions Bloomington:
Unsafe Working Conditions pdf icon | Word

V

W

Service Maintenance positions Bloomington:
Work History Supplement (see Employment Application)

X

Y

Z

 

 

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Page updated: 24 February 2014
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