human resources Forms

These documents are for SCSU department use only and should not be modified without consent from the Human Resources Department.

 

FREQUENTLY USED FORMS

Clerical Tuition Waiver

Confidentiality Statement

Direct Deposit

Dual Employment

Name/Address Change

W-4 CT Tax Form 2012

W-4 Federal Tax Form 2012

 

EMPLOYMENT FORMS

Application (State - HR-12, Classified Employees Only)

Background Investigation Authorization

Governor Rell's Ethics Statement

Graduate Assistant Appointment Form

I-9 Employment Eligibility Verification

Lecturer Appointment

Part Time Counselor Form

Personnel Action Form

University Assistant Appointment Form

 

Faculty Related Forms

10.12 Instructional Faculty Timesheet

AAUP Consulting Research Approval Form

Article 11 Compensation for Non-Instructional Educational Activities Form (Full-Time)

Article 12.8 Non-Instructional Educational Activities Form (Part-Time)

Instructional Faculty Authorization Form (10.12)

No Load Credit Form (10.12.1)

Outside Teaching Employment Request Form

Request for Time and/or Allocation Split

 

EVALUATION FORMS

Administrative Faculty

Administrative and Residual

Clerical

Maintenance

Management/Confidential

 

medical RELATED FORMS 

FMLA -HR1 Employee Request 

FMLA - HR2a Agency Response: Notice of Eligibility & Rights & Responsibilities

FMLA - HR2b Agency Response: Designation Notice

FMLA - HR2c CORE CT Coding

FMLA - HR3 Intent to Return to Work

Employee Med Cert Form (P33-A)

Caregiver Med Cert Form (P33-B)

Military Family Leave Form (WH-384, Employee)

Military Family Leave Form (WH-385, Service Member)

Reasonable Accommodation Request Form

Sick Leave Bank Grant Application - AAUP

Sick Leave Bank Grant Application - Management/Confidential

Sick Leave Bank Grant Application - SUOAF

 

retirement forms

Income Payment Election Form - Option A (50% Spouse)

Income Payment Election Form - Option B (50% or 100% Survivor)

Income Payment Election Form - Option C (10 or 20 Years Period Certain)

Inome Payment Election Form - Option D (Straight Life Annuity)

Limited Durable Power of Attorney Form (CO-1049)

Retirement Form (CO-931H)

 

Worker's Compensation Forms

WC Forms for supervisors

• Reference Guide
• Supervisor's Check List
• WC 207 First Report of Injury
• WC 207-1 Accident Investigation Report

 

WC Forms for employees

• Employee's Check List
• General Letter 78: Use of Accrued Leave with Worker's Comp
• WC 715 Use of Accruals
• WC 1A  Filing Status
• WC 211 Liability
• WC Physician's Status Report
• WC Employee Notice
  

 

other Forms

Duties Questionnaire

Incident Report - Facilities Operations

Incident Report - SCSU

Workplace Violence Reporting Form