Human Resources
Holloway Hall

HR Forms

The forms below are available in Word and PDF format. If you use Word documents, you may save the file and complete the form on your computer. Otherwise, you can print out the PDF version and complete by hand. You will need a PDF reader such as Acrobat Reader in order to view PDF files.

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 Forms for Non-Exempt Collective Bargaining Unit Employees

BU Holiday Pay [Word]  
BU Overtime List [Word]  
BU Summary Record of Absence-Tardiness [Word]  
BU Tuition Remission Addendum [Word]  

 Forms for Senior Citizens

SU Senior Citizen Tuition Remission Form [Word]  

 Forms for Incident Reporting & Unsafe Conditions


Link to Environmental Health & Safety

 Recruitment/New Hire Process

  For forms not listed below, please go to the Search and Selection page

  Ad Template - External Exempt Staff [Word]  
  Ad Template - External Non-Exempt Staff [Word]  
  Ad Template - Faculty [Word]  
  Ad Template - Internal [Word]  
Criminal History Check Release & Authorization Form   [PDF]
  Fair Credit Reporting Act (FCRA) - Summary of Rights   [PDF]
Employee Personal Data Sheet [Word]  
Employment Eligibility Verification (I-9)   [PDF]
  Personnel Electronic Requisition Instructions - Faculty Position   [PDF]
  Personnel Electronic Requisition Instructions - Staff Position   [PDF]
Position Description (PD) [Word]  
  Position Information (PI) [Word]  
Request for Temporary Services [Word]  
  SU Employment Application [Word]  
  Extra work history sheets (for above application) [Word]  

 Employment Contracts

Contingent I Exempt Contract [Word]  
  Contingent I Non-Exempt Contract [Word]  
Contingent I Contract Process Flow [Excel]  
Contingent I Hire Checklist [Word]  
  Contingent I SU Policy Sign-Off Page [Word]  
Dual Employment Form [Word]  
Exempt Contingent II Contract [Word]  
Non-Exempt Contingent II Contract [Word]  

Faculty Contracts (Links to Academic Affairs Webpage)

 Payroll Forms

Direct Deposit Authorization   [PDF]
W-4 Employee Withholding Allowance Certificate   [PDF]
  W-4 Instructions   [PDF]


  Dual Employment Policy [Word]  
  Employee Rights & Responsibilities under the Family and Medical Leave Act [Word]  
State of MD Substance Abuse Policy [Word]  
SU Policy Sign-Off Page [Word]  
  SU Sexual Harassment Policy & Procedure   [PDF]
  BOR Policy on Reporting of Suspected Child Abuse & Neglect [Word]  
  SU Policy on Reporting to Work & Attendance [Word]  

 Forms for Supervisors/Managers

Notice of Separation Form [Word]  
  Notice of Separation Form (form-fill) [Word]  
Overtime & Compensatory Time Authorization Form [Word]  
  Overtime & Compensatory Time Authorization Process [Word]  
PD Form for Exempt Employees [Word]  
PI Form for Non Exempt Employees [Word]  
Performance Management Process Forms    
- PMP Form For Non-Exempt Employees   [Excel
  - PMP Form For Exempt Employees (form-fill) [Word]  
  - PMP Form for Exempt Employees [Word]  
- PMP Instructions:  Using the Excel format [Word]  
- PMP Form for Contingent I [Word]  
- Probationary & Below Standards Evaluation [Word] [FormFill]
- Supervisor's Evaluation Check-off List   [Excel]
Permanent Schedule Change [Word]  
Progressive Discipline Forms    
- Disciplinary Notice Of Suspension [Word]  
  - Disciplinary Notice Of Suspension (for Bargaining Unit Employees) [Word]  
  - Disciplinary Notice Of Suspension (for Contingent Employees) [Word]  
- EAP Form [Word]  
- Record of Counseling - Verbal Reprimand [Word]  
- Return to Work Medical Certification [Word] [PDF]
  - Summary Record of Absence - Tardiness (for excluded Non-Exempt employees only) [Word]  
  NOTE for Non-Exempt Collective Bargaining Unit Employees, see top section
  - Summary Record of Absence - Tardiness for Contingent Employees [Word]  
  - Written Reprimand Notification [Word]
  - Written Reprimand Notification - Contingent [Word]  
  Job Analysis Request Packet    
  Request for Job Analysis [Word]  
  Job Analysis Classification - Employee Questionnaire [Word]  
  Job Analysis - Statement of Immediate Supervisor [Word]  
  Job Analysis - Statement of Department Head [Word]  

 Forms for Employees

Change of Name and/or Address (Complete new W-4)   [PDF]
"In the News" Form [Word]  
  Grievance Form [Word]  
Leave Request Form [Word]  
  Request to View/Copy Personnel File [Word]  
Unsafe Condition Reporting [Word]  

 Forms for Tuition Remission

  USM Request for Tuition Remission (TR)   [PDF]
USM Tuition Remission - Affidavit (A)   [PDF]
  - BU Tuition Remission Addendum [Word]  
  W-4 (REQUIRED for Retirees requesting TR for Spouse and/or Dependents)   [PDF]
  - W-4 Explanation Letter for Retirees   [PDF]
  - Working Condition Fringe Benefit Supervisor Certification

          (if applicable, for Employee Graduate Class only)

  Additional Information    
- Tax Chart - USM Tuition Remission   [PDF]
  - USM TR Deadlines and Restrictions Chart - Summer 2014   [PDF]
  - USM TR Deadlines and Restrictions Chart - Winter & Spring 2014   [PDF]

 Forms Related to Health Benefits

Affidavit for Dependent Eligibility   [PDF]
  Change of Name and/or Address (HR/Health Benefits)   [PDF]
  Disabled Dependent Certification Form   [PDF]
  Minnesota Life PA&D (Personal Accident & Dismemberment) Beneficiary Form   [PDF]
  Minnesota Life Term Life Insurance Beneficiary  Form   [PDF]
  UNUM Term Life & LTD Insurance Enrollment Form   [PDF]
  UNUM Term Life Insurance Beneficiary Form   [PDF]
Vision Service Forms (or related website):    
United Healthcare Vision Claim Form   [PDF]
Carefirst Vision Claim Form   [PDF]