FORMATS
There are several downloadable formats used on for HR forms. You can download a viewer
for any of these formats from the ASU online plug in center. Plug-in viewers are free to download.
E-FAX NUMBERS
HR Data Management |
480.993.0005
HR Background Checks |
480.993.0006
HR Benefits & Leaves |
480.993.0007
HR Retirement |
480.993.0008
| Form Name | Purpose / Description | Format |
|---|---|---|
A-C |
||
A-4
(Employee’s Arizona Withholding Percentage Election) |
Arizona State Income Tax Withholding | |
Aetna Evidence of Insurability |
Use to provide evidence of insurability when enrolling or increasing the amount of life insurance. | |
Academic Bi-Weekly Pay Calendar |
Bi-Weekly Pay Calendar for Academics | |
Announcement of Vacancy- Faculty/Academic Professional |
Use this form to open a vacancy announcement for an open Faculty/Academic Professional position. | PDF & Glossary |
Applicant List- for resumes sent directly to departments |
Use this form to track resumes received from applicants replying to a posted position. | |
Arizona Foundation Out-of-Network Claim |
Use to claim medical expenses. | External PDF |
Arizona State Retirement System |
Enrollment Form Beneficiary Form Change of Address or Name |
PDF |
ASU ID Number Change Request |
Employees Only - Use this form to request a change to an ASU ID number that is not a Social Security Number. | Word |
Background Verification |
Use these forms to perform a background verification for a new employee. | HR web page |
Benefit Declaration For Change/Enrollment Form |
Use to request changes to your benefit elections. | |
Certification of Health Care Provider (FMLA) |
Form used to certify medical condition for FMLA leave. | |
COBRA Enrollment Form |
Use to continue or decline insurance after loss of coverage. | |
Compassionate Transfer of Leave |
To Request Hours To Donate Hours Supervisor Memo |
PDF Word |
Compensation/ Classification Action Request |
Use this form to re-classify filled positions. | PDF or Word |
D-H |
||
Delta Dental Claim |
Use to submit a claim to Delta Dental. | |
Direct Deposit |
Form used to establish or change direct deposit of pay. | ASU Interactive |
| Use this form to fill an open position that needs an immediate hire. | PDF or Word | |
Equal Employment Opportunity Survey |
Voluntary form for new employees used by ASU to collect EEO data | |
Faculty and Academic Professional Search Plan |
Use when beginning a search for a faculty member or academic professional | |
| Information on Family Leaves | ||
FICA Refund Request |
Use this form when an employee requests a prior year refund on FICA OASDI and MEDICARE. | PDF or Word |
Flexible Employment Conversion Application |
Use this form to volunteer to reduce your time worked by one to six pay periods a year. | Word |
Flexible Spending Accounts |
Enrollment Form Change Form Claim Form Direct Deposit/Email Notification |
PDF External PDF External PDF |
| This form replaced Waiver of Recruitment | ||
| Form to comply with regulations regarding the taxation and reporting of payments made to individuals who are not residents for tax purposes. | PDF or Word | |
| Use this form to request approval to hire from EOAA and then submit to HR for processing of new hires. | PDF Word Glossary |
|
I-O |
||
I -9 |
Form for Employment Eligibility Verification | |
Independent Contractor Checklist |
Use this form for review and approval of Independent Contractors before performance of services begins. | PDF Word Glossary |
Leave of Absence and Hold Request |
Use to request a leave (e.g. Military, FMLA, Extended) | |
Leave of Absence Status Change Form |
For Supervisor Use Only | |
MetLife Dental Claim |
Use to submit a claim to MetLife Dental. | External PDF |
Military Leave Letter |
Form sent to employees to acknowledge request for Military leave. | |
New Employee Payroll Packet |
Payroll and other HR forms needed from new hires. | |
Non-Exempt Employee Calendar |
Alternate record for reporting time worked. Click on the tabs at the bottom of the spreadsheet for the pay period in which you are recording time worked. | Excel |
Overdraft Reimbursement |
||
Owner Automobile Mileage Report |
Report of miles driven for dealer owned automobiles. | Word |
P |
||
Pay Correction |
Form to correct employee's pay. Online (Manual) Check and Pay Correction (Direct Deposit) | Word |
Pay Option |
Form used to select payment options for faculty on academic year appointments. | PDF or Word |
Payroll Redistribution and Instructions |
Request a payroll expense transfer. | |
Personal Data Change |
Form used for existing employees to report changes of personal information. | ASU Interactive |
Position Change Request |
Use this form to change the position attributes of any Faculty/Academic Professional positions or any vacant Classified/Service Professional/Administrative positions. |
Word |
Post Offer of Employment Physical Exam Sheet |
Use this form when requiring an employee to have a physical examination. | PDF or Word |
Prescription Fax Order |
Use to have your physician fax a 90-day prescription to Walgreens Health Initiatives. | External PDF |
Prescription Mail Order |
Use to mail a 90-day prescription to Walgreens Health Initiatives. | External PDF |
Prescription Reimbursement |
Use to request a reimbursement from Walgreens Health Initiatives when you have paid out-of-pocket for a prescription. | |
R |
||
RAN+AMN Claim |
Use to claim out-of-area Urgent Care & Emergency expenses. | External PDF |
Recruitment Handbook |
Use for guidance in recruiting faculty and academic professsionals | |
Reinstatement for Spring 2008 |
Form for active spring Faculty, Graduates and Academic Professionals continuing in the same department | Word |
Release to Return to Work/Certificate of Illness |
Used when returning to work after a medical leave of absence. | |
ReliaStar Life Insurace |
Application Form Beneficiary Form Change Form |
PDF External PDF External PDF |
Request for Paid Time Off |
Word | |
Request to Pay OT in Lieu of Comp Time |
Pay overtime in lieu of compensatory time | Excel |
Retiree Benefit Enrollment/ Change Form |
Use to continue or decline insurance benefits at retirement. | External PDF |
Retirement Certificate Request |
Form to request certificate to honor ASU employees who retire with five or more years of continuous service |
|
RIF Analysis |
Use this form to perform a departmental analysis in the determination of a RIF. | PDF or Excel |
S |
||
Salary Reduction Agreement Authorization for Deductions |
Authorize/discontinue salary deductions for a Tax Sheltered Annuity Program. | |
Sample Offer Letter |
Use these sample templates to confirm Classified or Service Professional employment offers. | HR Advisor |
Sample Regret Letter (Budget) |
Use this form as a template to notify applicants that the position will not be filled at this time. | PDF or Word |
Sample Non-select Letter (Applicant) |
Use this form as a template to notify applicants that they were not selected. | Word |
Sample Non-select Letter (Interviewee) |
Use this form to notify applicants that have been interviewed, that they were not selected. | Word |
Savings Bonds |
Authorize a deduction from your pay to purchase U. S. Savings Bonds; or to change beneficiary. | |
Schaller Anderson Claim |
Use to claim out-of-area Urgent Care & Emergency expenses. | External PDF |
Sick Leave Accrual Verification |
To verify the sick leave balance of an employee retiring, or moving to a different Arizona State agency. | PDF or Word |
Summer Address |
Use this form to provide HR with your summer address information. | Word |
T-U |
||
Temporary Employment Request (External) |
Use this form when completing a Temporary Employment Request with an external temporary agency. |
Word |
Temporary Employment Request (Internal) |
Use this form when completing a Temporary Employment Request with Staffing Services. |
Word |
Time Adjustment |
Use this form to adjust an employees time. | Word |
Time Sheet |
For non-exempt employees to manually record work time | Word |
Tuition Waiver (1) |
Classes at any ASU campus: • Employee • Employee's spouse • Employee's dependent(s) |
Word |
Tuition Waiver (2) |
Classes at UA or NAU: • Employee, • Emplopyee spouse • Employee dependent(s) Classes at ASU, UA or NAU: • Retiree, their spouse and their dependent(s) • Eligible LTD participant, their spouse and their dependent(s) • Affiliate, their spouse and their dependent(s) |
Word |
2008 Tuition Waiver Dependent Questionnaire |
Word | |
UnitedHealthcare Claim |
Use to claim medical expenses. | External PDF |
V-Z |
||
Vacation/Compensatory Time Termination Worksheet |
Form used to calculate Vacation/Compensatory time for terminating employees. | PDF or Word |
Verification of Employment |
Use this form to request a verification of employment. | PDF or Word |
Vision Plan Out-of-Network Claim |
Use to claim out-of-network vision benefits. | External PDF |
W-2 Request |
Use this form to request a duplicate copy of a W-2 | Word |
W-4 |
Employee's Federal Income Tax Withholding Allowance Certificate | 2007 PDF 2008 PDF |
W-5 (Earned Income Credit) |
Use IRS Form W-5 if you are eligible to get part of the Earned Income Credit (EIC) in advance with your pay and choose to do so. | |
Waiver of Right to Pre-termination Hearing |
Form to be used if you have been notified to attend a pre-termination hearing and you will not attend. | Word |
Waiver of Recruitment |
This form has been replaced by Focused Recruitment Form | |
Walgreens Health Initiatives Mail Order Fax |
Use for physician to order 90-day prescription. | External PDF and Instructions |
Walgreens Health Initiatives Mail Order |
Use for employee to order 90-day prescription. | External PDF |
Walgreens Health Initiatives Prescription Reimbursement |
Use to request a reimbursement from Walgreens Health Initiatives when you have paid out-of-pocket for a prescription. | |
Workers' Compensation |
Flow Chart Employer's Report of Injury Supervisor's Incident Report Authorization for Payment Release To Return to Work |
PDF External PDF Word |