Virginia Commonwealth University

About Human Resources at VCU

Forms

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Benefits

Beneficiary Designation Forms pdf icon 

  • For Basic Life Insurance, Optional Life Insurance and VRS Retirement
  • Participants in the VCU Faculty Optional Retirement Plan (ORP) use this only to designate life insurance beneficiaries

For the VCU Faculty Optional Retirement Plan (ORP), VCU Tax-Deferred Annuity (TDA) and Cash Match accounts, and the Virginia Deferred Compensation Plan (DCP), see the following vendor websites or contact the vendor directly for appropriate beneficiary forms

Claim Forms

Deferred Compensation Plan (DCP) Enrollment Form (457) pdf icon 

Deferred Compensation Plan (DCP) Payroll Authorization Form pdf icon   

Deferred Compensation Plan (DCP) Payroll Authorization - Agency Transfer/Terminated Employee Return to work pdf icon

Deferred Compensation Plan (DCP) Payroll Authorization Form - One Time Deferral pdf icon

Employee certification form pdf icon

  • for purchase of VRS service credit

Flexible Reimbursement Account (FRA) – Enrollment Form PDF (effective through June 30, 2013)

Flexible Reimbursement Account (FRA) – Enrollment FormPDF (effective beginning July 1, 2013)

Health Benefits Enrollment Form pdf icon (effective through June 30, 2013)

Health Benefits Enrollment Formpdf icon (effective beginning July 1, 2013)

Health Insurance Program Appeal Form PDF 

Open Enrollment Checklist pdf icon (for health benefits and flexible spending changes effective July 1, 2013)

Optional Life Insurance Enrollment Form PDF

Optional Life Insurance Evidence of Insurability Form PDF

Optional Group Life Insurance Request for Change PDF 

Prescription Drug Prior Authorization Form PDF

  • for extended travel

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) PDF 

  • for submitting a change(s)

Tax-Deferred Annuity (TDA): Auto-Enrollment, New-Hire Opt-Out Form PDF

  • for new faculty and classified staff

VRS forms

VRS Member Benefit Profile Error Reporting Form PDF

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Compensation management

Compensation

Exempt Salaried - Other (EX Employee Class) Personnel Action Form (PAF) word icon

Overtime Leave Option pdf icon

Personnel Action Form (PAF) excel icon

Pay Action Worksheet (PAW) Word document

Pay Action Worksheet (PAW) and Pay Matrix - Information Technology Word document

Process for hiring hourly decentralized and centralized workers

Timesheet - weekly pdf icon

Timesheet - pay period (2013) excel icon

Timesheet - final Excel document  

Wage Position Description (WPD) Word document

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Employee health services

Employee Health Documentation Request Form Word document

  • Former VCU and VCUHS employees

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Employee relations

Grievance Form A: Email request for confidential assistance to VCU Employee Relations

Written Notice Form Word document

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Employment

Apply online

  • For classified, hourly and student openings

Child Support Disclosure Word document

Decentralized Employment Orientation 

Designate Employee for Inclement Weather Closings Word document

  • Only if designated to work during authorized closings

Employment Non-Selection Letter (Sample) Word document 

Form I-9 - Checklist for Completing pdf icon 

Form I-9 - Employment Eligibility Verification pdf icon

  • Use with remote employees after June 25, 2009

Form I-9 - U.S. Citizenship and Immigration Services Handbook for Employers pdf icon 

ImageNow

Offer letter for decentralized hires Word document

Orientation materials

PA/Hiring Manager New Hire/Rehire Resource Card pdf icon

PA/Hiring Manager Quick Reference for New Hires and Rehires pdf icon

  • These are critical forms required for all new employees

Policy Checklist for New Hires pdf icon

Reference Check Form pdf icon

Retirees - Procedures and Form for Part-Time Employment Word document

Selective Service Form pdf icon

Telecommuting Agreement Word document  

  • For ongoing telecommuting

Telecommuting Eligibility Checklist Word document

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Faculty forms

Adjunct Faculty Non-Teaching Position Description Word document

Continuing Education Instruction Form for Faculty Word document

Faculty Off-Cycle Bonus Award Word document

Faculty Off-Cycle Salary Increase Word document

Faculty Performance Development Form - Administrative and Professional Word document

Faculty Position Description - Administrative and Professional Word document

Overload Job Request Form - Faculty Employee Word document

  • Formerly called Faculty Second Job Approval Memo

Tuition waiver form (for full-time faculty and classified staff) word icon

Tuition waiver form (for full-time faculty and classified staff) [PDF]

Tuition waiver form (for adjunct faculty) word icon

Tuition waiver form (for adjunct faculty) [PDF]

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Leave administration

Accrual Rates: maximum carryover PDF

Certification of Health Care Provider PDF

Classified employee - Traditional Sick Leave Program Word document

Classified employee - Virginia Sickness and Disability Program Word document

Educational Leave Form [doc]

Family and Medical Leave Act (FMLA) Information and Forms

Leave reporting form for administrative and professional (A&P) or 12-month teaching and research (T&R) faculty in the:

Certification of Health Care Provider PDF

Leave Share Donor Form PDF

Leave Share Recipient Application PDF

Military Leave Worksheet PDF

Nine-Month Teaching and Research Faculty - Traditional Sick Leave Program Word document

Nine-Month Teaching and Research Faculty - Virginia Sickness and Disability Program Word document

Online Leave and Pay Adjustment forms

OT2 Form for Classified Primary Job with Overload Job Word document  

Overtime Leave Option pdf icon

Separating Faculty and Staff PDF

Study-Research Leave Form Word document 

Timesheet - weekly pdf icon 

Timesheet - pay period (2013) excel icon

Timesheet - final Excel document  

Timekeeping Tips PDF

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Payroll services

Awards and Prizes 

Direct Deposit Authorization Form Word document

Immigration Documents Needed for Non-U.S. Citizen Employees PDF

OT2 Form for Classified Primary Job with Overload Job Word document

Pay and Leave Adjustment Forms 

Payroll Deduction Authorization Form PDF

  • For Virginia Credit Union

Self Service Banner (SSB) - now eServices/VCU Self Service

  • Make online federal tax withholding changes, unless you meet one of the exceptions mentioned on the Tax Authorization Screen

Personnel File Request Form Word document 

Timesheet - weekly pdf icon

Timesheet - pay period (2013) excel icon

Timesheet - final Excel document  

Timekeeping tips PDF 

VA-4 Form - State Income Tax Withholding PDF

W-2 Request or Inquiry Form Word document

W-4 Form - Federal Income Tax Withholding PDF 

Wireless Exception Form Word document

Wireless Worksheet and Agreement Word document 

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Performance management

Acknowledgment of Extraordinary Achievement Word document

Employee Suggestion Program (ESP) 

Employee Work Profile (EWP)

Interim Evaluation Form Word document

Notice of Improvement Needed Word document

Probationary Period – Manager Overview PDF

Probationary Progress Review Word document

Self-Evaluation Form Word document

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Reward and recognition 

Awards and Prizes 

Customer Compass Recognition Form word icon

Dorris Douglas Budd Award word icon 

Employee Suggestion Program (ESP)

Finance and Administration Customer Compass Individual Award Nomination Form word icon

Finance and Administration Customer Compass Fun Award Nomination Form word icon

Monetary and Non-Monetary Award Taxing Guidelines PDF

President/Vice President-Approved and School/College Faculty Awards - Award Action Form PDF

Recognition Award Action Form for Classified Employees (Outstanding and Extraordinary Achievement) word icon

Recognition Award Action Form for Classified Employees (Outstanding and Extraordinary Achievement) PDF

Spot Award Action Form word icon

Spot Award Action Form pdf icon

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Training and development

Educational Leave Form [doc]

Personnel Administrator Certification (PAC) registration form word icon 

Personnel Administrator Certification (PAC) registration form pdf icon 

Personnel Administrator Certification (PAC) training checklist word icon

Personnel Administrator Certification (PAC) training checklist pdf icon

Professional Development Certificate Program (PDCP) enrollment form  word icon

Professional Development Certificate Program (PDCP) enrollment form [PDF] 

Professional Development Certificate Program (PDCP) training transcript word icon 

Professional Development Certificate Program (PDCP) training transcript pdf icon 

Study-Research Leave Form [doc]  

Training reimbursement/certification form [PDF]

Tuition waiver form (for full-time faculty and classified staff) word icon

Tuition waiver form (for full-time faculty and classified staff) [PDF]

Tuition waiver form (for adjunct faculty) word icon

Tuition waiver form (for adjunct faculty) [PDF]

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Transaction and records

Criteria for Identifying Other Eligible Veterans PDF

Personnel File Request Form Word document

Personal Data Form (PDF) Word document

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Workers’ compensation

Accident Report Form  word icon

Accident Report Form PDF

Physician Selection Form PDF

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Work/life resources

VCU volunteer cover letter Word document

VCU volunteer data form Word document

VCU volunteer fact sheet Word document

VCU volunteer health form Word document

VCU volunteer injury report form Word document

Virginia Emergency Response Team Participation Request Form word icon

Work/Life Seminar Evaluation PDF

Work/Life Service Request PDF

Work/Life Service Evaluation PDF

Weight Watchers Reimbursement Form PDF To be completed and submitted at the end of the meeting session

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05/07/2013