Forms

(by category)

Personal Data (address/name) • Benefits • Compensation • Employment/Hiring/Separation • Leave • Payroll and Taxes • Workers' Compensation 

Important Note: Most of the forms are in Portable Document Format (PDF). The forms have fields to be filled out online using Adobe Acrobat Reader version 4.0 or later. PDF forms should then be printed using the printer icon near the upper-left corner of the form. PDF forms with data cannot be saved or e-mailed unless "Save with 7.0+" is in the description. Read the form instructions closely. Many forms require signatures and hardcopy submission.

Benefits

Health

• Insurance Forms (link to ALL forms)
• Insurance Enrollment or Changes (Notice of Election)

State Health Plan (SHP)

• Health Expenses Claim Form and Instructions (two pages)
• Prescription Drug Claim Form (Coordination of Benefits/Direct) & Instructions (two pages)
• Request for Blue Cross and Blue Shield Card (SHP ID Card)
• Prescription Drug Home Delivery Order Form

CIGNA HealthCare Network (HMO)

• Health Expenses Claim Form
• Prescription Drug Claim Form

BlueChoice HealthPlan

• Health Expenses Claim Form

Cobra

• Notice of Election
• Rates Chart

Dental

• Dental Claim Form and Instructions

 Money Plu$

• 2011 MoneyPlu$ Enrollment form
• MoneyPlu$ Claim Form (interactive version – requires Adobe Acrobat Reader 7.0 or later)

Retirement

• Retirement Forms (link to ALL forms)
• Enrollment Form (ALL systems)
• Beneficiary Form – Beneficiary Designation, Contingent
• Beneficiary/Trustee Designation Form (ALL systems) 
• Election of Non-Membership
• State Optional Retirement program (ORP) Active Group Life Beneficiary Form (South Carolina Retirement System)
• Amount Change form for Supplemental Retirement Account

Compensation

• Bonus Request Form
• Compensatory Overtime Record (MS Word)
• Position Description (please use PeopleAdmin)
• Salary Change Request Form
• Temporary Salary Adjustment

Employment and Hiring and Separation

• Employee Application (please apply with PeopleAdmin)
• Employment Verification Release
• Background Check Forms:
  • Disclosure
  • Release and Authorization
• Position Description (please use PeopleAdmin)
• New Hire Justification
• Adjunct Appointment
• Temporary Appointment
• Request for Additional Pay
• Exit Checklist
• Zero Pay Adjunct Appointment
• Zero Pay Temporary Appointment

 Leave

• Advanced Sick Leave Request (MS Word)
• Application for Reduced Teaching for New Faculty Parents
• Additional 180 days Sick Request (MS Word)
• Leave Request Form
• Certification of Health Care Provider for Employee's Serious Health Condition (FMLA-WH380E)
• Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA-WH380F)
• Certification of Qualifying Exigency for Military Family Leave (FMLA WH-384)
• Physician Certification for Advanced Sick Leave and Leave Pool

Payroll and Tax

• W4
• W2 Reprint Request Form
• Direct Deposit
• Non-Immigrant Forms and Explanations:
  • FICA Exemption
  • Resident v. Non-Resident
  • Form 8843 Instruction

Personal Data

• Name/Address Change
• Personal Data Form

Workers' Compensation

• Employee Statement of Injury
• Extended Disability Notification (MS Word)
• Mileage Reimbursement (Excel)
• Supervisor Statement of Injury
• Witness Statement of Injury