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)  Word version  revised 10/2009 

Adjunct Faculty Non-Teaching Position Description  Word version 10/2009

Administrative & Professional Faculty Performance Development Form  

Administrative & Professional Faculty Position Description 
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) 

Banner Access, Forms and Guides 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)

• ING  (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 4/2009 
    Classified Recognition Award Guidelines  

See also Monetary and Non-Monetary Award Taxing Guidelines

Continuing Education Instruction Form for Faculty  Word version  revised 3/2009

D

Decentralized Employment Orientation

Deferred Compensation Plan (457) Forms

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

Direct Deposit Authorization Form  Word version  revised 10/2009
    Direct Deposit FAQs    
Dorris Douglas Budd Award Nomination Form  Word version      

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)

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

    Draft Objectives and Competencies

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 (Rev. 02/02/09 N) - for use ONLY with remote employees AFTER June 25, 2009

        Checklist for Completing Form I-9s

        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) 

     PA/Hiring Manager New Hire/Rehire Resource Card

Retirees - Procedures and Form for Part-Time Employment  Word version  revised 11/2009

Working Offsite Agreement now Telecommuting Agreement  Word Version  revised 1/2009
    see also Telecommuting Eligibility Checklist  Word Version   revised 1/2009 

Extraordinary Achievement, Acknowledgement of  Word version

F

Faculty Continuing Education Instruction Form  Word version3/2009

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  revised11/2009

Faculty Overload Job Request Form  Word version  (formerly, Faculty Second Job Approval Memo)2/2008; revised 5/2009  

Family and Medical Leave Act (FMLA) Information and Forms

Federal Income Tax Withholding (W-4 Form)

   Use Self Service Banner (SSB) 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 

G

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

H

Health Benefits Enrollment Form

Eligibility Definitions and Required Documentation for Health Coverage

Proof of Dependent Eligibility

Health Insurance Program Appeal Form

I

I-9 Employment Eligibility Verification (Rev. 02/02/09 N) - for use ONLY with remote employees AFTER June 25, 2009

    Checklist for Completing Form I-9s 

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

ImageNow Fax Instructions

Immigration Documents Needed for Non-U.S. Citizen Employees  4/2009

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:  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) 5/2007

    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) Word version  revised 10/2009 

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  revised 11/2009

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 5/2007

Overload Job Request Form - Faculty Employee  Word version  (formerly, Faculty Second Job Approval Memo)2/2008; revised 5/2009 

Overtime Leave Option  revised 5/2009

P

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

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

    Online Leave and Pay Adjustment Procedure  revised 10/2008

Payroll Deduction Authorization Form (for Virginia Credit Union)

Performance Management (Classified Employees)

Personal Data Form (PDF)  Word version  revised 10/2009 

    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 11/2009

PAF Reference Guide 

Physician Selection Form  revised 1/2008  

Policy Checklist - for new hires   revised 1/2009

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]
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 4/2009 
    Recognition Award Guidelines for Classified Employees 

See also Monetary and Non-Monetary Award Taxing Guidelines

Reference Check Form  revised 8/2009

Request for Copy of Employee Personnel File
Retirees - Procedures and Form for Part-Time Employment  Word version  revised 11/2009

S

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) 2010

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) 2009

Selective Service Form - males only - not required if question is answered on employment application  revised 10/2008

Self-Evaluation Form  Word version 

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) 2010

Tax-Deferred Annuity (TDA): Salary Reduction Agreement (SRA) 2009

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) 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)

    Immigration Documents Needed for Non-U.S. Citizen Employees  4/2009 

Telecommuting Agreement  Word Version (formerly, Working Offsite Agreement)  revised 1/2009 
   and Telecommuting Eligibility Checklist  Word Version  revised 1/2009

Timekeeping Forms:
   Leave Reporting Forms:  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) 5/2007

        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 9/2008   

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 12/2008 

U

V

VA-4 Form - State Income Tax Withholding 

VCU Volunteers:  6/2008

VCU Volunteer Cover Letter (for PAs)  Word version  revised 6/2009

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)  Word version  revised 10/2009

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

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) 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 2/2009 

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 now Telecommuting Agreement  Word Version   revised 1/2009
  see also Telecommuting Eligibility Checklist  Word Version   revised 1/2009

Work/Life Seminar Evaluation

Work/Life Service Request / Work/Life Service Evaluation  

Written Notice Form  Word version  revised 7/2007

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)

• ING  (for DCP only)

Deferred Compensation Plan (457) Forms    

    Deferred Compensation Plan Payroll Authorization Form 

Flexible Reimbursement Account - Enrollment Form

Flexible Reimbursement Account - Reimbursement Form 

Health Benefits Enrollment Form

Eligibility Definitions and Required Documentation for Health Coverage

Proof of Dependent Eligibility

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) 2010

Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA) 2009

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

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)  revised 2/2009 

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

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

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 (Rev. 02/02/09 N) - for use ONLY with remote employees AFTER June 25, 2009
   Checklist for Completing Form I-9s
   U. S. Citizenship and Immigration Services (USCIS) Handbook for Employers
ImageNow Fax Instructions
Orientation materials
Personnel Administrator/Hiring Manager Quick Reference for New Hires and Rehires (critical forms required for all new employees)
    PA/Hiring Manager New Hire/Rehire Resource Card
Retirees - Procedures and Form for Part-Time Employment  Word version  revised 11/2009
Telecommuting Agreement  Word Version  (formerly, Working Offsite Agreement)  revised 1/2009
   and Telecommuting Eligibility Checklist  Word version  revised 1/2009  

Faculty Forms
Adjunct Faculty Non-Teaching Position Description  Word version 10/2009

Continuing Education Instruction Form for Faculty  Word version3/2009

Faculty Off-Cycle Bonus Award

    Instructions for Off-Cycle Faculty Bonus Award

Faculty Off-Cycle Salary Increase  revised11/2009

Overload Job Request Form - Faculty Employee  Word version  (formerly, Faculty Second Job Approval Memo)2/2008; revised 5/2009 

Faculty Performance Development Form - Administrative & Professional  

Faculty Position Description - Administrative & Professional 

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible full-time faculty and classified staff]  revised 9/2008    

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 12/2008   

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:  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) 5/2007

    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 10/2009
    Direct Deposit FAQs    
Employee Personnel File Request Form  Word version

Immigration Documents Needed for Non-U.S. Citizen Employees  4/2009

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

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

    Online Leave and Pay Adjustment Procedure 

    Timekeeping Tips

Payroll Deduction Authorization Form (for Virginia Credit Union)

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) 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) - sample - see eJobs@VCU
    Performance Evaluation  Word version  revised 8/2006
    Instructions
    Draft Objectives and Competencies
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 4/2009
    Classified Recognition Award Guidelines 

See also Monetary and Non-Monetary Award Taxing Guidelines

Dorris Douglas Budd Award Nomination Form  Word version 
Employee Suggestion Program (ESP)

 
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 9/2008   

Tuition Waiver Form - print and fill in  Word version - type directly onto form  [for eligible adjunct faculty]  revised 12/2008  

Transaction and Records
Employee Personnel File Request Form  Word version
Personal Data Form (PDF)  Word version  revised 10/2009

   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  

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