HR and Payroll Forms

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  Click here to browse forms and schedules in alphabetical order.

Click here to browse forms and schedules by HR service area.

Forms and Schedules Listed in Alphabetical Order 

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

Accident Report Form   
Acknowledgment of Extraordinary Achievement  Word version 
Address Change -- Use  Personal Data Form (PDF) 

Administrative & Professional Faculty Performance Development Form  

Administrative & Professional Faculty Position Description 
Adjunct Position Description for non-teaching or non-physician assignments Word version  revised 7/2008  
Applicant Information

     For VCU employment, applicants use  eJobs@VCU; see also VCU Applicant Information  

B

Background Check -

See Personnel Administrator/Hiring Manager Quick Reference for New Hires and Rehires (critical forms required for all new employees)  revised 6/2008

Banner Access, Forms and Guides  New 5/2006

Beneficiary Designation Forms:

• For Basic Life Insurance, Optional Life Insurance, and VRS Retirement, use the VRS Beneficiary form 

[Note:  Participants in the VCU Faculty Optional Retirement Plan (ORP) use this form 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 Web sites or contact the vendor directly for appropriate beneficiary forms:

• Fidelity Investments  (for ORP, TDA, and Cash Match)

• TIAA-CREF  (for ORP, TDA, and Cash Match)

• VALIC   (for TDA only)

• Great-West  (for DCP only)

C

Certification of Health Care Provider  1/2008

Child Support Disclosure Form  Word version

Classified Recognition Award Action Form  Word version  revised 4/2007 
    Classified Recognition Award Guidelines  revised 4/2007 

See also  Monetary and Non-Monetary Award Taxing Guidelines 9/26/2007

CommonHealth@VCU:

• Health-Check Screening - Payroll Deduction Form  Word version

• CPR Training - Payroll Deduction Form  Word version

D

Decentralized Employment Orientation

Deferred Compensation Plan (457) Forms   

    Deferred Compensation Plan Payroll Authorization Form 
Designate Employee for Inclement Weather Closings  Word version  

Direct Deposit Authorization Form   Word version   revised 2/2008
    Direct Deposit FAQs    
Dorris Douglas Budd Award Nomination Form      

E

Educational Leave Form  revised 7/1/2007

eJobs@VCU:  Click here to apply on-line for classified job openings at VCU.  Click here for applicant information. 
Employee Health Documentation Request Form  Word version  [for former VCU and VCUHS employees]   revised 5/2008
Employee Personnel File Request Form   Word version
Employee Suggestion Program (ESP)   

See also  ESP home page

Employee Work Profile (EWP) - see eJobs@VCU
    Performance Evaluation  Word version  revised 8/2006
    Instructions 

    Draft Objectives and Competencies8/16/2007 

Employment
    Applicants use eJobs@VCU for VCU employment; see also VCU Applicant Information  
    Designate Employee for Inclement Weather Closings  Word version  [if designated to work during authorized closings] 

    Employment Non-Selection Letter (Sample)  Word version

    I-9 Employment Eligibility Verification 

    Checklist for Completing Form I-9s  revised 6/2008

    U. S. Citizenship and Immigration Services (USCIS) Handbook for Employers

Orientation materials

Personnel Administrator/Hiring Manager Quick Reference for New Hires and Rehires (critical forms required for all new employees)  revised 6/2008

     PA/Hiring Manager New Hire/Rehire Resource Card 1/2008; revised 6/2008

Procedures and Form for Part-Time Employment of Retirees

Working Offsite Agreement   revised 11/1/06 

Extraordinary Achievement, Acknowledgement of  Word version

EZ Reimburse MasterCard for Medical Flexible Reimbursement Account (FRA) expenses.  Click here for more information

F

Faculty Performance Development Form - Administrative & Professional  

Faculty Position Description - Administrative & Professional
Faculty Off-Cycle Bonus Award

    Instructions for Off-Cycle Faculty Bonus Award

Faculty Off-Cycle Salary Increase

Faculty Overload Job Request Form (formerly, Faculty Second Job Approval Memo)2/2008 

Faculty Second Job Approval Memo - changed to Overload Job Request Form - Faculty Employee 2/2008 

Family and Medical Leave Act (FMLA) Information and Forms

Federal Income Tax Withholding (W-4 Form)

   Use  Self Service Banner (SSB) (click "Employees" button and follow login process) to make federal tax withholding changes on-line 

          [unless you meet one of the exceptions mentioned on the Tax Authorization Screen]

Finance and Administration Customer Service Awards
    F&A Guidelines

    Individual Award Nomination Form

    Informal Award Form

Flexible Reimbursement Account - Enrollment Form

Flexible Reimbursement Account - Reimbursement Form   

Flexible Reimbursement Account - EZ Reimburse MasterCard for Medical Flexible Reimbursement Account (FRA) expenses.  Click here for more information

Flu Vaccine:  Payroll Deduction Form  Word version  and  Consent Form  Word version

See also Vaccine Information Statements (VIS) for flu vaccine and for Thimerosal, Latex, and Gentamicin Allergies

G

Grievance Form A (e-mail request for confidential assistance to VCU Employee Relations)

H

Health Benefits Enrollment Form (good through June 30, 2008)

Health Benefits Enrollment Form (effective July 1, 2008)

Health Insurance Program Appeal Form

I

I-9 Employment Eligibility Verification

Checklist for Completing Form I-9s  revised 6/2008

U. S. Citizenship and Immigration Services (USCIS) Handbook for Employers

Inclement Weather Closings--Designate Employee to Work  Word version  

Information Technology Pay Action Worksheet and Pay Matrix 

Interim Evaluation Form  Word version 

J

Job Openings -- applicants use eJobs@VCU; see also VCU Applicant Information  

K

L

Leave Reporting Forms:  New 3/2006  

    Administrative & Professional or 12-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

    Administrative & Professional or 12-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)

    Classified Employee - Traditional Sick Leave Program (TSLP)

    Classified Employee - Virginia Sickness and Disability Program (VSDP)

    Nine-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

    Nine-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)

Leave and Pay Adjustment Forms (on-line) New 5/7/2007

    Online Leave and Pay Adjustment Procedure

    Timekeeping Tips

Leave Share Donor Form  
Leave Share Recipient Application 

M

Military Leave Worksheet  

N

Name Change -- Use Personal Data Form (PDF) 

New Hire/Rehire critical forms and processes - Quick Reference for PAs and Hiring Managers -- see Employment

Notice of Improvement Needed  Word version
 

O

Off-Cycle Faculty Bonus Award

    Instructions for Off-Cycle Faculty Bonus Award

Off-Cycle Faculty Salary Increase

Offer letter for decentralized hires

See also Decentralized Employment Orientation

Orientation materials

Optional Life Insurance Enrollment Form   
Optional Life Insurance Evidence of Insurability Form   

Optional Group Life Insurance Request for Change

OT2 Form for Classified Primary Job with Overload Job  Word version  revised 5/10/2007

Overload Job Request Form - Faculty Employee (formerly, Faculty Second Job Approval Memo)2/2008 

Overtime Leave Option  revised 3/3/2008

P

Pay Action Worksheet (PAW) 
    Information Technology Pay Action Worksheet and Pay Matrix

Pay and Leave Adjustment Forms (on-line) New 5/7/2007

    Online Leave and Pay Adjustment Procedure

Payroll Deduction Forms:

• CommonHealth@VCU

• Health-Check Screening - Payroll Deduction Form  Word version

• CPR Training - Payroll Deduction Form  Word version

• Flu Vaccine - Payroll Deduction Form  Word version  and  Consent Form  Word version

See also Vaccine Information Statements (VIS) for flu vaccine and for Thimerosal, Latex, and Gentamicin Allergies

Performance Management (Classified Employees)

Personal Data Form (PDF) 

    Criteria for Identifying Other Eligible Veterans  [for use with Personal Data Form (PDF)]

Personal Service Agreements (PSAs) 4/2008:  PSAs are no longer in use; instead, follow the Overload Jobs policy or see Payment Methods for Non-Employees and Employees

Personnel File Request Form   Word version

Personnel/Position Action Form (PAF) - Banner  revised 7/9/2008

PAF Reference Guide  revised 7/1/2008

Physician Selection Form  revised 1/2008  

Policy Checklist - for new hires

See also Decentralized Employment Orientation

Position Description - Administrative & Professional Faculty 

Position Description - Non-teaching or Non-physician Adjunct Assignments Word version
Position Description (WPD) - Wage   

Prescription Drug Prior Authorization Form  [for extended travel]
Procedures and Form for Part-Time Employment of Retirees   
Professional Development Certificate Program Enrollment Form   Word version  revised 2/2007

Q

Quick Reference New Hire/Rehire critical forms and processes (for PAs and Hiring Managers) -- see Employment

R

Recognition Award Action Form for Classified Employees  Word version  revised 4/2007 
    Recognition Award Guidelines for Classified Employees  revised 4/2007

See also  Monetary and Non-Monetary Award Taxing Guidelines 9/26/2007

Reference Check Form

Request for Copy of Employee Personnel File
Request for Faculty Off-Cycle Salary Increase

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

S

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) 2008

Selective Service Form - males only - not required if question is answered on employment application

Self-Evaluation Form  Word version 

Sitter Roster Application
State Health Insurance Program Appeal Form

State Income Tax Withholding Form (VA-4)

Study-Research Leave Form  revised 7/1/2007

T

Tax-Deferred Annuity (TDA): Salary Reduction Agreement (SRA) 2008

Tax-Deferred Annuity (TDA): Auto-Enrollment - New-Hire Opt-Out Form (for new faculty and classified staff)  12/2007

Tax Withholding Forms:

    Federal Income Tax Withholding (W-4 Form)
       Use  Self Service Banner (SSB) (click "Employees" button and follow login process) to make federal tax withholding changes on-line

[unless you meet one of the exceptions mentioned on the Tax Authorization Screen]   

    State Income Tax Withholding Form (VA-4)

Timekeeping Forms:
   Leave Reporting Forms:  New 3/2006 

        Administrative & Professional or 12-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

        Administrative & Professional or 12-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)

        Classified Employee - Traditional Sick Leave Program (TSLP)

        Classified Employee - Virginia Sickness and Disability Program (VSDP)

        Nine-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

        Nine-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)  

   Leave and Pay Adjustment Forms (on-line) New 5/7/2007

        Online Leave and Pay Adjustment Procedure

        Timekeeping Tips

Training Reimbursement/Certification Form  Word version  revised 3/2007  

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible full-time faculty and classified staff]  revised 11/1/2007   

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 11/1/2007 

U

V

VA-4 Form - State Income Tax Withholding 

VCU Volunteers:  6/2008

VCU Volunteer Cover Letter (for PAs) Word version 

VCU Volunteer Data Form  Word version

VCU Volunteer Fact Sheet  Word version

VCU Volunteer Health Form  Word version

Veterans - Criteria for Identifying Other Eligible Veterans -- for use with Personal Data Form (PDF)

Virginia Emergency Response Team (VERT) Participation Request Form   Word version 12/12/2007; revised 1/31/2008 

Virginia Public Service Week (VPSW) 

    VCU Nomination Form for Classified Staff

VRS Forms  [VRS website]
VRS Member Benefit Profile Error Reporting Form

W

W-2 Request or Inquiry Form  Word version  revised 1/2006

W-4 Form - Federal Income Tax Withholding

    Use  Self Service Banner (SSB) (click "Employees" button and follow login process) to make federal tax withholding changes on-line 

           [unless you meet one of the exceptions mentioned on the Tax Authorization Screen]

Wage Position Description (WPD)  revised 6/2008 

See also  Process for Hiring Hourly Workers (decentralized and centralized)

Weight Watchers Reimbursement Form (to be completed and submitted at the end of the meeting session)

Workers' Compensation Accident Report Form

Workers' Compensation Physician Selection Form  revised 1/2008
Worker's Right to Know Statement

    See  Office of Environmental Health and Safety   
Working Offsite Agreement   revised 11/1/2006
Work/Life Seminar Evaluation

Work/Life Service Request / Work/Life Service Evaluation  

Work/Life Sitter Application 

Written Notice Form  Word version  revised 7/10/2007

X

Y

Z

Forms and Schedules Listed in Order by HR Service Area

Benefits

Beneficiary Designation Forms:

• For Basic Life Insurance, Optional Life Insurance, and VRS Retirement, use the VRS Beneficiary form 

[Note:  Participants in the VCU Faculty Optional Retirement Plan (ORP) use this form 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 Web sites or contact the vendor directly for appropriate beneficiary forms:

• Fidelity Investments  (for ORP, TDA, and Cash Match)

• TIAA-CREF  (for ORP, TDA, and Cash Match)

• VALIC   (for TDA only)

• Great-West  (for DCP only)

Deferred Compensation Plan (457) Forms    

    Deferred Compensation Plan Payroll Authorization Form 
Flexible Reimbursement Account - Enrollment Form

Flexible Reimbursement Account - Reimbursement Form 

Flexible Reimbursement Account - EZ Reimburse MasterCard for Medical Flexible Reimbursement Account (FRA) expenses.  Click here for more information

Health Benefits Enrollment Form (good through June 30, 2008)

Health Benefits Enrollment Form (effective July 1, 2008)

Health Insurance Program Appeal Form  

Optional Life Insurance Enrollment Form  
Optional Life Insurance Evidence of Insurability Form

Optional Group Life Insurance Request for Change
Prescription Drug Prior Authorization Form  [for extended travel]

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) 2008

VRS Forms  [VRS website]
VRS Member Benefit Profile Error Reporting Form

Compensation Management 
Pay Action Worksheet (PAW)    
    Information Technology Pay Action Worksheet and Pay Matrix

Wage Position Description (WPD) 

See also  Process for Hiring Hourly Workers (decentralized and centralized)

Employee Health Services
Employee Health Documentation Request Form  Word version  [for former VCU and VCUHS employees]   revised 5/2008
Flu Vaccine:  Payroll Deduction Form  Word version  and  Consent Form  Word version

See also Vaccine Information Statements (VIS) for flu vaccine and for Thimerosal, Latex, and Gentamicin Allergies

Employee Relations
Grievance Form A (e-mail request for confidential assistance to VCU Employee Relations)
Written Notice Form  Word version  revised 7/10/2007

Employment
Click here to apply on-line for classified, hourly, and student job openings at VCU.  Click here for applicant information. 

Designate Employee for Inclement Weather Closings  Word version  [if designated to work during authorized closings]

Employment Non-Selection Letter (Sample)  Word version

I-9 Employment Eligibility Verification

Checklist for Completing Form I-9s  revised 6/2008

U. S. Citizenship and Immigration Services (USCIS) Handbook for Employers

Orientation materials

Personnel Administrator/Hiring Manager Quick Reference for New Hires and Rehires (critical forms required for all new employees)  revised 6/2008

 PA/Hiring Manager New Hire/Rehire Resource Card 1/2008; revised 6/2008

Procedures and Form for Part-Time Employment of Retirees

Working Offsite Agreement   revised 11/1/2006 

Faculty Forms
Adjunct Position Description for non-teaching or non-physician assignments  Word version

Faculty Off-Cycle Bonus Award

    Instructions for Off-Cycle Faculty Bonus Award

Faculty Off-Cycle Salary Increase

Faculty Overload Job Request Form (formerly, Faculty Second Job Approval Memo)2/2008 

Faculty Performance Development Form - Administrative & Professional  

Faculty Position Description - Administrative & Professional

Faculty Second Job Approval Memo - changed to Overload Job Request Form - Faculty Employee 2/2008 

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible full-time faculty and classified staff]  revised 11/1/2007   

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 11/1/2007  

Leave Administration

Certification of Health Care Provider  1/2008

Educational Leave Form  revised 7/1/07
Family and Medical Leave Act (FMLA) Information and Forms
Leave Reporting Forms:  New 3/2006

    Administrative & Professional or 12-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

    Administrative & Professional or 12-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)

    Classified Employee - Traditional Sick Leave Program (TSLP)

    Classified Employee - Virginia Sickness and Disability Program (VSDP)

    Nine-Month Teaching & Research Faculty - Traditional Sick Leave Program (TSLP)

    Nine-Month Teaching & Research Faculty - Virginia Sickness and Disability Program (VSDP)

Leave and Pay Adjustment Forms (on-line) New 5/7/2007

    Online Leave and Pay Adjustment Procedure

    Timekeeping Tips

Leave Share Donor Form  
Leave Share Recipient Application   
Military Leave Worksheet 
Study-Research Leave Form  revised 7/1/2007

Payroll Services
Direct Deposit Authorization Form   Word version   revised 2/2008
    Direct Deposit FAQs    
Employee Personnel File Request Form   Word version

OT2 Form for Classified Primary Job with Overload Job   Word version  revised 5/10/2007 

Pay and Leave Adjustment Forms (on-line) New 5/7/2007

    Online Leave and Pay Adjustment Procedure

    Timekeeping Tips

Payroll Deduction Forms:

• CommonHealth@VCU

• Health-Check Screening - Payroll Deduction Form  Word version

• CPR Training - Payroll Deduction Form  Word version

• Flu Vaccine - Payroll Deduction Form  Word version  and  Consent Form  Word version

See also Vaccine Information Statements (VIS) for flu vaccine and for Thimerosal, Latex, and Gentamicin Allergies

Personal Service Agreements (PSAs) 4/2008:  PSAs are no longer in use; instead, follow the Overload Jobs policy or see Payment Methods for Non-Employees and Employees

VA-4 Form - State Income Tax Withholding
W-4 Form - Federal Income Tax Withholding

   Use  Self Service Banner (SSB) (click "Employees" button and follow login process) to make federal tax withholding changes on-line 

          [unless you meet one of the exceptions mentioned on the Tax Authorization Screen]

W-2 Request or Inquiry Form  Word version  revised 1/2006

Performance Management (Classified Employees)  
Acknowledgment of Extraordinary Achievement  Word version 
Employee Work Profile (EWP) - see eJobs@VCU
    Performance Evaluation  Word version  revised 8/2006
    Instructions
    Draft Objectives and Competencies8/16/2007 
Interim Evaluation Form  Word version 
Notice of Improvement Needed  Word version 
Probationary Progress Review  Word version  
    Probationary Period - Manager Overview
Self-Evaluation Form  Word version 

Reward and Recognition 
Classified Recognition Award Action Form  Word version  revised 4/2007 
    Classified Recognition Award Guidelines  revised 4/2007 

See also  Monetary and Non-Monetary Award Taxing Guidelines 9/26/2007

Dorris Douglas Budd Award Nomination Form        

Employee Suggestion Program (ESP)   

See also ESP home page

 
Finance and Administration Customer Service Awards 
    F&A Guidelines
    Individual Award Nomination Form
    Informal Award Form    
Virginia Public Service Week (VPSW) 
    VCU Nomination Form for Classified Staff

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible full-time faculty and classified staff]  revised 11/1/2007   

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 11/1/2007 

Transaction and Records
Employee Personnel File Request Form   Word version
Personal Data Form (PDF)

   Criteria for Identifying Other Eligible Veterans   [for use with Personal Data Form (PDF)

Workers' Compensation 
Accident Report Form   
Physician Selection Form  revised 1/2008  

Work/Life Resources
 

Work/Life Seminar Evaluation

Work/Life Service Request / Work/Life Service Evaluation  

Work/Life Sitter Application 

Weight Watchers Reimbursement Form (to be completed and submitted at the end of the meeting session) 

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