Forms

Benefits

Workers’ 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.

Classification & Compensation

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.

Talent Acquisition

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 Hiring Training Manual – Outlines the process of hiring benefited staff
Staff Hiring Workflow – Visually outlines the staff hiring process
Staff Hiring Guidance – Explains recruitment options
Staff Hiring Search Checklist – Provides step-by-step instructions on the staff interviewing and selection process
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
Transition Document – Provided with the offer letter to new employees

Temporary Hiring

Temporary Hiring Manual – Outlines the process of hiring temporary employees
Temporary Hiring Workflow – Visually outlines the temporary hiring process
Temporary Hiring Checklist – Provides step-by-step instructions on the temporary hiring process
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 Hiring Form – Completed by hiring manager and given to a new temporary employee prior to attending an on-boarding session

Student Hiring

Student Hiring Manual – Outlines the process of hiring student employees
Student Hiring Workflow Visually outlines the student hiring process
Student Hiring Checklist – Provides step-by-step instructions on the student hiring process
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
New Employee Hiring Form – Completed by hiring manager and given to a new student employee prior to attending an on-boarding session 
Student ‘Get Paid’ Checklist – Checklist for students after they have been offered the job to guide them through the Onboarding process

Employee Relations

• Verbal Warning 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.
→Personnel Action Form Instruction Manual Link

Separation Checkout Form (for Employees)- Form for an employee who has resigned or been terminated.

Separation Checkout Form (for Supervisor)– 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.