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Forms A to Z Following is an alphabetical listing of the Human Resource-related forms. To help in locating a form, some of the same documents are listed with multiple names. Click on the appropriate letter to locate the document you desire.   To search by area of interest, click here. 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 Academic Leave Certification Form for Sick Leave Accidental Death and Dismemberment Brochure Accrual Rate Election Form - Annual Leave Address and/or Name Change Form - Employment Records Address Change - La. State Employees' Retirement System Address Change - Teachers' Retirement System of La. Alien Tax Information Request Form Always Vision Plan Change Form Always Vision Plan Features and Enrollment Form Ameritas Dental Enhanced Plan Features and Enrollment Form Ameritas Dental Basic Plan Features and Enrollment Form Ameritas Dental Basic Plan Schedule of Benefits Ameritas Dental Enhanced Plan Schedule of Benefits Annual Leave Accrual Rate Election Form Asset Protection Plan - Sign Up Today Form Asset Protection Plan - Informational FAQ Brochure B                    (Return to Top) Bank of America Corporate Travel Application Bene-Dent - Dental Change Form Beneficiary and/or Name Change Form - Prudential Life Insurance Beneficiary Change Form - LSU System Life Insurance (ING) Beneficiary Designation and Change Form - CSRS Beneficiary Designation and Change Form - Prudential Life Insurance Beneficiary Designation Form - La. State Employees' Retirement System Beneficiary Designation Form - Teachers' Retirement System of La. Beneficiary Designation Form - Louisiana Deferred Compensation Plan Benefits Coverage While on Leave Without Pay (GI-1) Election Form Benefits Schedule Booklet Bi-Weekly Timesheet - PDF or Word C                    (Return to Top) Campus Federal Payroll Deduction Form Car Insurance Agreement-LCES Civil Service Pre-Employment Application (SF-10) - PDF or Word Civil Service Position Description (SF-3) - PDF or Word COBRA - Dental & Vision Plan Continuation Comparison and Summary of Health Plans Coursework Request Form CPTP Registration Form - PDF or Word Credit Union Payroll Deduction Form Critical Care Information Brochure Critical Care Claim Form CSRS Beneficiary Designation and Change Form CSRS Refund of Contributions Application D                    (Return to Top) Deferred Compensation Plan Beneficiary Form Deferred Compensation Plan Enrollment Form Definity Health Plan Claims Processing Details Definity Health Plan Mid-Year Hires Prorated Deductibles Definity Health Plan Prescription Fax & Mail Order Form Definity Health Plan Reimbursement Form - Non-Pharmacy Definity Health Plan Reimbursement Form -Prescriptions Definity Health Plan Snapshot Definity Health Plan Supplemental Medical Benefit Claim Form Denta-Care - Dental Change Form Dental - Ameritas Basic Plan Features & Enrollment Form Dental - Ameritas Enhanced Plan Features & Enrollment Form Dental - Ameritas Basic Plan Schedule of Benefits Dental - Ameritas Enhanced Plan Schedule of Benefits Dental Change Form - Ameritas Dental Change Form - Denta-Care Dental Change Form - La. Dental Dental Change Form - Bene-Dent Dental Change Form - Paid Dental Dental & Vision Plan Continuation Under COBRA Direct Deposit Form (Payroll Check) Direct Deposit Waiver (Payroll Check) Direct Deposit Form (Tax Saver Flexible Benefits Plan) Driver Record Verification and Vehicle Authorization Form E                    (Return to Top) Educational/Sabbatical Leave Request Form Employment Application - Civil Service (SF-10) - PDF or Word Employment Application - Extension Faculty-Extension Agent Employment Eligibility Verification Form - I-9 Employment of a Minor Form Employment Packet Request - PDF Employment Screening Form - PDF or Word EPO Helpful Information Booklet Exchange Visitor (J1) Extending Visa - Unit Instructions - PDF or Word Exchange Visitor (J1) Obtaining Visa - Unit Instructions - PDF or Word Exit Checklist - PDF or Word Extension Faculty Employment Application - Extension Agent F                    (Return to Top) Faculty Job Description Form (PS-46) - PDF or Word Family Medical Leave Act Notification Form Federal Tax Form - W-4 - Employee Withholding Allowance Certificate Federal Tax Form - W-5 FMLA Notification Form Form 1945 - Social Security Admin. (Employment in a job not covered by SS) Form 8233 - Exemp. from Withholding on Comp. for Independent (and Certain                    Dependent) Personal Services of a Nonresident Alien Individual G                    (Return to Top) GB-01 - Group Benefits Enrollment/Change Form GI-1 - Benefits Coverage While on Leave Without Pay Election Form Group Benefits Enrollment/Change Form (GB-01) H                    (Return to Top) H1B1 Extension - Unit Instructions - PDF or Word H1B1 New Petition - Unit Instructions - PDF or Word Hartford Longterm Disability Enrollment Form Hartford Longterm Disability Evidence of Insurability/Disability Form Hartford Longterm Disability Claim Form Health Insurance Portability Law Form Health Insurance Pre-Existing Condition Form Health Plans Summary and Comparison Chart Health Plans Rates Holiday Schedule (PS-5) Housing Agreement I                    (Return to Top) I-9 Form - Employment Eligibility Verification Form Illegal Use of Drugs or Alcohol - Policy Statement 18 ING Life Insurance (LSU System) Beneficiary Change Form ING Life Insurance (LSU System) Change Form ING Life Insurance (LSU System) Enrollment Form ING Life Insurance (LSU System) Evidence of Insurability Insurance Portability Law Form - Health Insurance Intention to Employ a Minor International Visitor - Request for Arrangements - PDF or Word Interview and Selection Process Interview Form - Extension Agent Interview Selection Requirements for Agents J                    (Return to Top) J1 Exchange Visitor Extension - Unit Instructions - PDF or Word J1 Exchange Visitor Obtaining Visa - Unit Instructions - PDF or Word K                    (Return to Top) L                    (Return to Top) L-4 - Louisiana State Tax Form - Employee Withholding Certificate L-4E - Louisiana State Tax Form - Exemption From Withholding La. Dental - Dental Change Form La. State Employees' Retirement System Address Change La. State Employees' Retirement System Beneficiary Designation La. State Employees' Retirement System Enrollment Form La. State Employees' Retirement System Name Change Form La. State Employees' Retirement System Refund Contributions Form La. State Employees' Retirement System Refund Rollover Form LASERS SSA-1945 (Employment in a job not covered by Social Security) Leave Accrual Selection Form Leave Without Pay - Benefits Coverage Election (GI-1) Life Insurance and Long Term Care Change Form Life Insurance - Extension Benevolent Beneficiary Form Life Insurance - Extension Benevolent Enrollment Form Life Insurance (ING-LSU System) Enrollment Form Life Insurance (ING-LSU System) Beneficiary Change Form Life Insurance (ING-LSU System) Change Form Life Insurance (ING-LSU System) Evidence of Insurability Life Insurance (Prudential) Beneficiary and/or Name Change Form Life Insurance (Prudential) Beneficiary Designation & Change Form Life Insurance (Prudential) Claim Form Life Insurance (Prudential) Enrollment Form Life Insurance (Prudential) Evidence of Insurability Form Long term Care and Life Insurance Change Form Long term Care Brochure Long term Care Enrollment Form Long term Care Evidence of Insurability (E of I) Form Long term Care Medicare Disclosure Long term Care Policy Information Long term Care Rates (3 year benefit) Long term Care Rates (6 year benefit) Long term Care Worksheet Long term Disability (Hartford) Enrollment Form Long term Disability (Hartford) Evidence of Insurability/Disability Form Long term Disability (Hartford) Claim Form Louisiana Deferred Compensation Plan Beneficiary Form Louisiana Deferred Compensation Plan Enrollment Form Louisiana Deferred Compensation Plan Information Sheet Louisiana State Tax Form - L-4 Louisiana State Tax Form - Exemption From Withholding - L-4E Form LSU System Life Insurance (ING) Beneficiary Change Form LSU System Life Insurance (ING) Change Form LSU System Life Insurance (ING) Enrollment Form LSU System Life Insurance (ING) Evidence of Insurability Form M                    (Return to Top) Medical Certification N                    (Return to Top) Name and/or Address Change Form - Employment Records Name and/or Beneficiary Change Form - Prudential Life Insurance Name Change - La. State Employees' Retirement System Name Tag Information New Employee Orientation Checklist New Employee Orientation Schedule and Registration O                    (Return to Top) Offer Letter - Agent Offer Letter - Associate Offer Letter - Postdoctoral Researcher Offer Letter - Unclassified Optional Insurance Election Form Optional Retirement Plan Enrollment/Change Form Orientation Checklist for New Employees Orientation Schedule & Registration Form Outside Employment Disclosure Form - PM-11 Forms A & B P                    (Return to Top) Paid Dental - Dental Change Form Payroll Deduction Form - Campus Federal Credit Union Payroll Voucher (Manual - MUST BE TYPED) PER 1A - Personnel Action Form (Print on Yellow Paper) - PDF PER 1B - Personnel Action Form (Print on Yellow Paper) - PDF or Word PER 2 - Personnel Action Form (Print on Yellow Paper) - PDF or Word PER 17 - Turn Around Document Performance Appraisal Form - CS General - PDF or Word Performance Appraisal Form - CS Nutrition Educator - PDF or Word Performance Appraisal Form - CS Administrative (Clerical) Support - PDF or Word Performance Evaluation Form - Associate/Postdoc Researcher - PDF or Word Performance Evaluation Form - Faculty - PDF or Word Performance Evaluation Form - Non-Classified - PDF or Word Personnel Action Form - PER 1A (Print on Yellow Paper) - PDF Personnel Action Form - PER 1B (Print on Yellow Paper) - PDF or Word Personnel Action Form - PER 2 (Print on Yellow Paper) - PDF or Word PM-11 Outside Employment Disclosure Forms A & B Policy Statement 5 - Holiday Schedule Policy Statement 18 - Illegal Use of Drugs or Alcohol Policy Statement 37 - Return to Work Following Illness or Injury PPO Helpful Information Booklet Portability Law - Health Insurance Position Advertisement and Selection Record - PDF or Word Position Description - Civil Service - SF-3 - PDF Position Vacancy Announcement Format - Extension Agent (4-H) Position Vacancy Announcement Format - Extension Agent (Ag) Position Vacancy Announcement Format - Postdoc Researcher Position Vacancy Announcement Format - Professor Position Vacancy Announcement Format - Research Associate Postdoc Researcher/Associate Performance Evaluation Form - PDF or Word Post Retirement Life Insurance Change Form Pre-existing Condition Form - Health Insurance Prescription Reimbursement Form - Definity Health Plan Primary Care Physician Election Form - Humana Promotion/Tenure Review Request Form - Word or PDF  Provident Universal Life Insurance Change Form Prudential Life Beneficiary and/or Name Change Form Prudential Life Beneficiary Designation and Change Form Prudential Life Claim Form Prudential Life Evidence of Insurability Form Prudential Life Insurance Enrollment Form Prudential Life Insurance Rates - Active and Retired Under Age 65 Prudential Life Insurance Rates - Active and Retired Age 65-69 Prudential Life Insurance Rates - Active Age 70 and up Prudential Life Insurance Rates - Retired Age 70 and up PS-5 - Holiday Schedule PS-18 - Illegal use of Drugs or Alcohol PS-37 - Return to Work Policy Following Illness or Injury) Q                    (Return to Top) R                    (Return to Top) Rates for Health Plans Request for Arrangements for International Visitor - PDF or Word Request for Employment Packet - PDF Research Associate Supplemental Job Description Form - PDF or Word Resignation Letter Retirement Application Form Retirement Election Form - Temporary or Part-time Employee Retirement Enrollment Application - Teachers' Retirement System of La. Retirement Refund of Contribuitons - Federal Civil Service Retirement System Retirement Refund of Contributions - LASERS Retirement Refund of Contributions - LASERS - Rollover Authorization Retirement Refund of Contributions - Teachers' Retirement System of La. Retirement - TRSL or ORP ... How Do I Choose? Return to Work Policy (After Illness or Injury) - (PS-37) S                    (Return to Top) Sabbatical/Educational Leave Request Form Sample Letter to Applicant Not Selected for Postion Schedule of Employee Benefits Booklet Selective Service Verification Instructions SF-3 - Civil Service Position Description - PDF or Word SF-10 - Civil Service Pre-Employment Application - PDF or Word Sick Leave Certification Form - Academic Employees SSA.-1945 (Employment in a job not covered by SS) SSA-1945-LASERS SSA-1945-TRSL Staff Benefits Coverage While on LWOP Stop Payment Request Student Employment Application Student Timesheet - PDF or Word Summary and Comparison of Health Plans Supplemental Employment Form Supplemental Job Description Form - Research Associate - PDF or Word Supplemental Retirement Account Election/Salary Reduction Authorization Form T                    (Return to Top) Tax Saver Flexible Benefits Plan Booklet Tax Saver Flexible Benefits Plan Claim Form - (Must logon to ProcessWorks Inc.) Tax Saver Flexible Benefits Plan Debit Card Instructions Tax Saver Flexible Benefits Plan Direct Deposit Form Tax Saver Flexible Benefits Plan Enrollment Form Tax Saver Flexible Benefits Plan Frequently Asked Questions (FAQ's) Tax Saver Flexible Benefits Plan Over The Counter (OTC) Drugs Reimbursement Tax Saver Flexible Benefits Plan Status Change Form Tax Withholding - Federal W-4 Tax Withholding - Federal W-5 (Exemption From Withholding) Tax Withholding - State L-4 Tax Withholding - State L-4E (Exemption From Withholding) Teachers' Retirement System of La. Address Change Form Teachers' Retirement System of La. Beneficiary Designation Teachers' Retirement System of La. Enrollment Form Teachers' Retirement System of La. Refund of Contributions Timesheet - Bi-Weekly - PDF or Word Timesheet - Student - PDF or Word TN Canadian Status - Obtain TN Status and Employ TN Canadian Status - Extend TN Status and Continue Employment TRSL SSA-1945 (Employment in a job not covered by Social Security) Turn Around Document (PER 17) U                    (Return to Top) UNUM Long term Care Change Form UNUM Long term Care Brochure UNUM Long term Care Enrollment Form UNUM Long term Care Evidence of Insurability (E of I) Form UNUM Long term Care Medicare Disclosure UNUM Long term Care Policy Information UNUM Long term Care Rates (3 year benefit) UNUM Long term Care Rates (6 year benefit) UNUM Long term Care Worksheet V                    (Return to Top) Vehicle Authorization and Driver Record Verification Form Visa - H1B1 Extension - Unit Instructions - PDF or Word Visa - H1B1 New Petition - Unit Instructions - PDF or Word Visa - Extending J1 Exchange Visitor Status - Unit Instructions - PDF or Word Visa - Obtaining J1 Exchange Visitor Status - Unit Instructions - PDF or Word Visa - Extending TN Canadian Status - Unit Instructions Visa - Obtaining TN Canadian Status - Unit Instructions Vision & Dental Plan Continuation Under COBRA W                    (Return to Top) W-4 Federal Tax Form (Employee Withholding Certificate) W-5 Federal Tax Form (Exemption From Withholding) Worker's Compensation Notice of Compliance Poster Worker's Compensation Incident/Accident Investigation Form Worker's Compensation Employer Report of Injury/Disease Worker's Compensation Medical Authorization Release - PDF or Word Worker's Compensation Prescription Drug Benefits X                    (Return to Top)  Y                    (Return to Top)   Z                    (Return to Top)

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