University Human Resource Services
Home Benefits Salary Employee relations Employment HRMS Policies Training

 

 

Indiana University

University Human Resource Services

Forms

Search forms:
Browse forms:
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

Applicant Monitoring Form PDF

Authorization Form for Motor Vehicle Records Check (Risk Management) 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

Dental expenses (CIGNA) pdf icon

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

Medical expenses for all plans pdf icon

Mental health expenses (IUPM) for PPO $900 Deductible pdf icon

Prescription expenses (Wellpoint/NextRx) for all plans pdf icon

TSB-HRA healthcare and dependent care expenses pdf icon

Bloomington:
Classification Appeal Form Word

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

Certification of Eligibility for Dependent Child Age 19 or Older - 2008pdf icon

Certification of Eligibility for Dependent Child Age 19 or Older - 2009pdf 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 pdf icon

Termination of Domestic Partnership pdf icon

E

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

Service Maintenance positions Bloomington:
Employment Application Form globe icon | pdf icon | RTF version
Work History Supplement pdf icon

Essential and Marginal Job Functions Worksheet Word 2007

F

Fee Courtesy (see Tuition Benefit)
 

Fidelity Investments

Fidelity IU Retirement Plan Enrollment and Beneficiary Designation Form PDF
Plan # 57524

Fidelity IU Retirement Savings 457(b) Plan Enrollment and Beneficiary Designation Form PDF
Plan # 71301

Fidelity IU TDA Plan Enrollment and Beneficiary Designation 403(b) Form PDF
Plan # 51913

Fitness for Duty/Return to Work Medical Release Influenza A (H1N1) PDF

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

Hourly Employees Print and complete

Professional and Non-union Support and Service Staff print and complete

Bloomington:
Service Maintenance Employees Print and complete
Support Staff Print and complete

H

Hourly positions at Bloomington

Employment Applicationglobe icon | pdf icon | RTF version

Education and Work History Supplement globe icon | pdf icon | RTF version

Position Posting Request Formglobe icon

I

I-9 Form pdf iconand Instructions

Bloomington:
Incident Report (Staff) print and complete

IU Retirement Plan

Investment Company Change Form pdf icon

Fidelity IU Retirement Plan Enrollment and Beneficiary Designation Form PDF
Plan # 57524

TIAA-CREF IU Retirement Plan 403(b) RA Enrollment Form PDF
Plan ID 100265

IU Retirement Savings Plan 457(b)

Salary Deferral Agreement Form pdf icon

Fidelity IU Retirement Savings 457(b) Plan Enrollment and Beneficiary Designation Form PDF
Plan # 71301

TIAA-CREF IU Retirement Savings Plan 457(b) GSRA Enrollment Form PDF
Plan ID 100268

IUSERP

Investment Company Change Form pdf icon

Fidelity Enrollment Form PDF

TIAA-CREF IUSERP 401(a) GRA Enrollment Form PDF
Plan ID 100266

IU Tax Deferred Annuity Plan 403(b)

Salary Deferral Agreementpdf icon

Fidelity IU TDA Plan Enrollment and Beneficiary Designation 403(b) Form PDF
Plan # 51913

TIAA-CREF IU TDA 403(b) GSRA Enrollment Form PDF
Plan ID 100267

IU Tuition Benefit (see Tuition Benefit)

J

K

L

Leaves for Military Families Request Form globe icon | pdf icon

Long-term Disability Insurance

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 pdf icon

Medical History Statement for Non-Indiana Residents pdf icon

Medical History Statement for Residents of Indiana pdf icon

Medical Savings Contribution Change Form (IU HDHP PPO & Medical Savings Plan) PDF

Mid-Year Salary Adjustment Form for Professional Staff

Standard form Word 2003 Word 2007

Form to use with 5 or more funding sources Word 2003 Word 2007

Motor Vehicle Records Check -- Authorization Form (Risk Management) pdf icon

N

O

P

PAO and PAU employee timesheets

PERF Change Beneficiary PDF

PERF Change of Name or Address PDF

PERF Investment Direction PDF

PERF Request for Estimate of Benefits 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

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

Position Description Word 2003 Word 2007

Position Requisition pdf iconand Guidelines

Prescription Expenses Claim for (Wellpoint/NextRx) pdf icon

Prescription Mail Order Form (Anthem) for PPO $900 Deductible and Blue Preferred Primary POSpdf icon

Q

R

Reasonable Accommodation Request and Documentation Form PDF

Retiree Health Care Enrollment Form (under age 65) pdf icon

Fitness for Duty/Return to Work Medical Release Influenza A (H1N1) PDF

Recognition Plan Document Word

Reward Plan Document Word

S

Salary

Mid-Year Salary Adjustment Form for Professional Staff

Standard form Word 2003 Word 2007

Form to use with 5 or more funding sources Word 2003 Word 2007

Separating Employment from IU

Employee Checklist pdf icon

Supervisor Checklist pdf icon

Service Maintenance positions Bloomington

Employment Applicationglobe icon | pdf icon | RTF version

Work History Supplement pdf icon

 

Bloomington:
Staff Incident Report print and complete

Bloomington:
Staff Position Posting Request Form globe icon

Student health insurance

International Dependent Enrollment Form 2008-09 pdf icon

International Continuation Form - Fall 2008 pdf icon

International/SAA Temporary ID card pdf icon

IU Health Center Claim Form pdf icon

SAA/Fellowship Dependent Enrollment Form 2008-09 pdf icon

SAA/Fellowship Continuation Form - Fall 2008 pdf icon

Undergraduate and Graduate Voluntary Enrollment Form (Student Health Insurance) pdf icon

Visiting Scholars and Dependents Enrollment Form 2008-09 pdf icon

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

Claim form for expenses (TSB & HRA)pdf icon

Dependent Care Flexible Spending Account Worksheet (TSB) pdf icon

Direct Deposit Authorization/Termination form (TSB & HRA) pdf icon

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

Bloomington:
Telephone Reference Check pdf icon

TIAA-CREF

IU Retirement Plan 403(b) RA Enrollment Form PDF
Plan ID 100265

IU Retirement Savings Plan 457(b) GSRA Enrollment Form PDF
Plan ID 100268

IUSERP 401(a) GRA Enrollment Form PDF
Plan ID 100266

IU TDA 403(b) GSRA Enrollment Form PDF
Plan ID 100267

Timesheets

PAE (Exempt) Staff PTO Record Card

PAO and PAU Staff Timesheets

Tobacco-free HRA

Claim form for expenses (TSB & HRA)pdf icon

Direct Deposit Authorization/Termination form (TSB & HRA) pdf icon

Tuition Benefit (formerly Fee Courtesy)

2009-2010 IU Tuition Benefit Enrollment Form globe icon | pdf

2008-2009 IU Tuition Benefit Enrollment Form pdf

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 pdf icon

X

Y

Z

 

 

 

Page updated: 12 June 2009
UNIVERSITY HUMAN RESOURCE SERVICES
Poplars E165, 400 E. 7th St., Bloomington, IN 47405 • (812) 855-2172
Contact Us

Indiana University is an Equal Employment Opportunity/Affirmative Action employer
and a provider of ADA services.