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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.

Worker’s Comp

Accident Witness Statement – Completed by individuals who witness on-the-job accidents.

Employee’s Report of Injury – Employees complete this form following a work-related injury.

Supervisor’s Accident Investigation – Supervisors 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) – Required of an employee when requesting to be placed on Family Medical Leave (FML)
Certification of Healthcare Provider (Form B)  (Revised 8/2021) – Required from an attending physician to verify an employee’s serious illness
Certification of Healthcare Provider for Family Members (Form C) (Revised 8/2021)  – Required for a family member’s serious health condition
Intent to Return to Work (Form D) – 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) – Required to determine the eligibility of the employee to return to work following a serious health condition
FML Designation/Approval Form (Form F) – Required of management to notify Human Resources (Benefits) of approval of FMLA when no certification is required
Extension for Faculty FML (Form G) – 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) – Required for an employee seeking FMLA leave due to a qualifying exigency to submit a certification
Reasonable Accommodation Form – Complete if you are requesting a reasonable accommodation. A majority of this form must be completed by the employee’s physician.

The Classification and Compensation department is currently updating forms associated with their processes. Please contact us at 478-6947 if you have any questions related to Classification and Compensation at Georgia Southern University.

Background Investigation Consent Form – Use this form for an individual who needs to complete a background investigation, academic credentials verification, or credit check. Do NOT use this link if your candidate is being hired through Careers. 

Staff Hiring

Staff – Request to Hire Form
Staff_Temp – Hiring Timeline
Staff – Hiring Manager Checklist
Sample Questions – Provides a list of legal and illegal interview questions.
Telephone Reference Check Form – Used by hiring managers to verify the professional references of candidates
New Employee Checklist – Used by supervisors and new employees to ensure the employee is made aware of all necessary information
Canned Responses for Hiring Managers

Temporary Hiring

Temp – Request to Hire Form
Staff_Temp – Hiring Timeline
Temp – Hiring Manager Checklist
Sample Questions – Provides a list of legal and illegal interview questions.
Telephone Reference Check Form – Used by hiring managers to verify the professional references of candidates
New Employee Checklist – Used by supervisors and new employees to ensure the employee is made aware of all necessary information
Canned Responses for Hiring Managers

Student Hiring

Student – Request to Hire Form
Student – Hiring Timeline
Student – Hiring Manager Checklist
Sample Questions – Provides a list of legal and illegal interview questions.
Telephone Reference Check Form – Used by hiring managers to verify the professional references on candidates
Student ‘Get Paid’ Checklist – Checklist for students after they have been offered the job to guide them through the Onboarding process
Canned Responses for Hiring Managers

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.
→Personnel Action Form Instruction Manual Link

Employee Separation Checklist – Form for an employee who has resigned or been terminated.

Supervisor Separation Checklist – Form for a supervisor of an employee who has resigned or been terminated.

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.

Performance Evaluations – copies of the evaluation forms and further information can be found at this link.

Last updated: 5/19/2022

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Contact Information

Department of Human Resources

Statesboro Campus
P.O. Box 8104
Statesboro, Georgia 30460
Phone: (912) 478-6947
Fax: (912) 478-0325


Armstrong Campus
11935 Abercorn Street
Savannah, Georgia 31419
Phone: (912) 478-6947
Fax: (912) 344-3455

Department of Human Resources

Statesboro Campus: P.O. Box 8104 • Statesboro, Georgia 30460 • 912-478-6947

Armstrong Campus: 11935 Abercorn Street • Savannah, Georgia 31419 • 912-478-6947

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