Benefit Forms

Flex Spending

Dependent Care Flexible Spending Account Claim - Form required for requesting reimbursement from your Flexible Spending Account for dependent care expenses.

Health Care Flexible Spending Account Claim - Form required for requesting reimbursement from your Flexible Spending Account for health care expenses.

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Workers' Comp

Accident Witness Statement - This form is for individuals who witness on-the-job accidents.
Employee's Report of Injury - Employees should complete this form following a work-related injury.
Supervisor's Accident Investigation - Supervisors are to complete this form when one of their employees is injured on-the-job.

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Medical Leave Assistance (formerly Shared Leave)

Medical Leave Assistance Program Donor and Recipient - Use this form if you would like to:
-Request leave from the Medical Leave Assistance Program.
-Donate to leave to a particular person.
-Donate additional hours.

Medical Leave Program Membership Form - Complete this form to join the Medical Leave Assistance program and designate the number of hours you would like to donate.

Medial Leave Assistance Program Physician's Confirmation - An individual who is requesting leave from the Medical Leave Assistance Program must have their physician complete this form.

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FMLA Forms

FMLA Request Form (Form A) - Form required of an employee when requesting to be placed on Family Medical Leave (FML).

Certification of Healthcare Provider (Form B) - Form required from an attending physician to verify an employee's serious illness.

Certification of Healthcare Provider for Family Members (Form C) - Form required for a family member's serious health condition.

Intent to Return to Work (Form D) - This form is completed by the department and sent to the employee on the tenth (10) week of employee using Family Medical Leave.

Medical Evaluation to Return to Work (Form E) - Form required to determine the eligibility of the employee to return to work following a serious health condition.

FML Designation/Approval Form (Form F) - Form requires of management to notify Human Resources (Benefits) of approval of FMLA when no certification is required.

Extension for Faculty FML (Form G) - Form required of a faculty member to request permission to extend the probationary period, the faculty member shall complete the following form.

Qualifying Exigency for Military (Form H) - Form required for an employee seeking FMLA leave due to a qualifying exigency to submit a certification. Reasonable Accomodation Form - Complete this form if you are requesting a reasonable accommodation. A majority of this form must be completed by the employee's physician.

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Leave of Absence without Pay

Personal Leave of Absence Without Pay - Form required for an employee seeking approval for leave of absence without pay.

Medical Leave of Absence Without Pay - Form required for an employee seeking approval for leave without pay for medical reasons.

Classification & Compensation

Position Summary Review Request - Form required to determine a classification of a new position, reclassification of an existing position, or for an external equity request. This document should not be printed, please fill out and submit electronically.

Position Revision Form - Form request to update a job description.

Employment Services

PeopleAdmin Account Request Form - Form used to add/delete and make changes to you account in PeopleAdmin

Staff Hiring

Staff Hiring Training Manual - Manual that outlines the process of hiring benefited staff.

Staff Hiring Workflow - Document is used to visually outline the staff hiring process.

Staff Straight Replacement Guide - Guide that outlines the actions taken by hiring managers to submit a vacant position for recruitment.

Staff Hiring Search Checklist - Document which provides step-by-step instructions on the staff interviewing and selection process.

Sample Questions - Document which provides a list of legal and illegal interview questions.

Telephone Reference Check Form - Form is used by hiring managers to verify the professional references of candidates.

Temporary Hiring

Temporary Hiring Manual - Manual that outlines the process of hiring temporary employees.

Temporary Hiring Job Posting Form - Form is used by hiring managers to inform Human Resources that a temporary position needs to be posted for recruitment.

Temporary Hiring Workflow - Document is used to visually outline the temporary hiring process.

Temporary Hiring Checklist - Document which provides step-by-step instructions on the temporary hiring process.

Sample Questions - Document which provides a list of legal and illegal interview questions.

Telephone Reference Check Form - Form is used by hiring managers to verify the professional references of candidates.

Temporary Hiring Information Form - Form is completed by hiring manager and given to a new temporary employee prior to attending an on-boarding session.

Student Hiring

Student Hiring Manual - Manual that outlines the process of hiring student employees.

Student Employment Job Posting Form - Form is used by hiring managers to inform the Student Employment Center that a student position needs to be posted for recruitment.

Off-Campus Job Posting Form - Form is used by external businesses to inform the Student Employment Center that a position needs to be posted.

Student Hiring Workflow - Document is used to visually outline the student hiring process.

Student Hiring Checklist - Document that provides step-by-step instructions on the student hiring process.

Sample Questions - Document which provides a list of legal and illegal interview questions.

Telephone Reference Check Form - Form is used by hiring managers to verify the professional references on candidates.

Hiring Proposal Information Sheet - Form is used by hiring managers to collect personal information from new employees so the hiring proposal can be completed.

Student Employee Hiring Form - Form is completed by hiring manager and given to a new student employee prior to attending an on-boarding session.

Background Investigation Consent Form - Form is used for an individual which needs to complete a background investigation, academic credentials verification, or credit check.

Employee Relations

Performance Evaluation - Starting in 2011, Georgia Southern will use the performance evaluation module through PeopleAdmin.

Performance Expectation Plan - Suggested form to help employees understand their performance by gaining a greater comprehension of their work expectations.

Verbal Warning / Counseling Documentation

Written Warning Documentation

Other Helpful HR Forms

Exit Questionnaire

G4 Georgia State Tax Form - Complete this form to indicate withholding allowances.

Non-Disclosure Agreement Form - Suggested form to indicate that an employee understands that in the course of your their employment at GSU, they may have access to information that is confidential, proprietary, or sensitive.

Personnel Action Form - Form to be completed when any personnel changes or actions are made.

Separation Checkout Form - Form required of an employee who has resigned or been terminated.

Tuition Assistance Program (TAP) Application - Form required of an employee who is interested in taking academic courses and requesting tuition assistance.

Fitness for Duty - Supervisor will complete and fax back this form to Human Resources. This form will include a behavioral description of the circumstances leading to the request for evaluation, and a list of the employee's relevant duties.