Forms

In an effort to provide forms that are both functional and cross-platform compatible, we have chosen to use the Adobe Acrobat application. You may need to download or upgrade the free Adobe Acrobat Reader by clicking the link below.

Benefit Forms

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. This investigation is to be completed within three days of the injury.  (If you a need a copy, please check the “Send me a copy of my responses” box at the bottom prior to clicking Submit.)
GA Activity Analysis


Shared Sick Leave Program

Sick Leave Program Enrollment Form 
Sick Leave Program Request Form 

Shared Sick Leave Member Termination Form 


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)  (Revised 6/2015) – Form required from an attending physician to verify an employee’s serious illness.
Certification of Healthcare Provider for Family Members (Form C) (Revised 6/2015)  – 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.


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

Please contact Nancy Whitfield at 478-0628 if you have any questions.

Resume Worksheet(Please download this form before filling it out.)  Form is to be used for detailing both current and prior work experiences.

Employment Services

PeopleAdmin Account Request Form – Form used to add/delete and make changes to your account in PeopleAdmin

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

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 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.
New Employee Checklist – Form used by supervisors and new employees to ensure the employee is made aware of all necessary information.
Transition Document – Form is provided with the offer letter to new employees.

Temporary Hiring

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

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(OPEN IN INTERNET EXPLORER!) Form to be completed when any personnel changes or actions are made.
Personnel Action Form Instruction Manual Link

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.

Last updated: 6/23/2017

DEPARTMENT OF HUMAN RESOURCES • P.O. Box 8104 • Statesboro, Georgia 30460 • (912) 478-5468