Welcome to the Department of Human Resources
Forms Library
Forms can be downloaded in Microsoft Word or Adobe Acrobat formats. the Acrobat plugin is a free download from Adobe.
Employment | Compensation/Classification | Benefits | Employee Relations | Hiring Managers | Family & Medical Leave Act | Performance Management | Payroll
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| CSU Nondiscrimination and Anti-harassment Policy |
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| CSU Employee Data Form -This is form is completed form employees at the time of hire. |
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| Form W-4: Employee's Withholding Allowance Certificate -Employees are required to complete this form to designate their dependents and tax withholdings. |
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| Form G-4: Employee's Withholding Allowance Certificate
(State of Georgia) -This form is used to designate their dependents and tax withholdings for the state of Georgia. |
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| I-9 -This meets the IRCA requirement of determining eligibility to work in U.S. New employees must satisfy this requirement within 72 hours. |
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| Security Oath -This is form is completed by regular employees at the time of hire. It is mandated by the board of regents. |
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| Authorization for Release - Standard Check - Also known as Basic Criminal History Check authorization, required for all new employees. Authorization for Release - Comprehensive Check - Also known as Comprehensive Criminal History Check authorization, required for all new employees occupying positions of trust. |
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| Exit Interview Form -This form is completed by employees leaving the University in order to provide confidential feedback to Human Resources and University Administration. |
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| Clearance of Campus Form -This form is completed by employees who are leaving campus and submitted to the Payroll Department for final action. |
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| -- Compensation / Classification -- | ||
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Position Description Form - This form is used for classification of new positions and to assist managers in creating a job description. |
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| Benefit Cost Estimate Worksheet |
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| Request for Additional Staff Compensation |
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| -- Benefits -- | ||
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| 2004 State Charitable Contributions Program Enrollment Form |
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| A.D.A. Physician's Assessment
Form -For completion by physician of employee requesting accommodation under ADA. |
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| Benefits
At A Glance - 2008 - This document provides an overview of benefits offered at Clayton State University. |
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| Benefits Election Summary Sheet
2008 -This form is used to summarize benefits elections and/or waivers for New Hires. |
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| Blue Cross Blue Shield Enrollment Form - This form is used to elect coverage in the BCBS PPO, BOR Indemnity Medical, Blue Choice HMO, HDHP, and/or the BOR Indemnity Dental plan. |
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| Blue Cross Blue Shield Enrollment Change Form - This form is used by the employee to make changes to his/her existing BCBS PPO, BOR Indemnity Medical, Blue Choice HMO, HDHP, and/or the BOR Indemnity Dental plan. |
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| Blue Cross Blue Shield Cancellation Authorization Form - This form is used to cancel coverage in the BCBS PPO, BOR Indemnity Medical, Blue Choice HMO, HDHP, and/or the BOR Indemnity Dental plan. |
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| Cigna Enrollment/Change Form - This form is used to enroll in or make changes to CIGNA’s life insurance plans. |
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| Cigna Beneficiary Designation Form - This form is used to change beneficiary designations. |
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| Delta Dental Enrollment/Change
Form -This form is completed by the employee who wishes to elect Delta Dental or make changes to his/her existing plan. |
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| Dependent Flexible Spending
Account Enrollment Form -This form is used to elect participation in the Dependent Care Flexible Spending Account. |
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| Dependent Care Flexible Spending Account Claim Form - This form is used to request reimbursement for eligible dependent care flexible spending account expenses. |
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| Fidelity Enrollment Form -This form is used to enroll in Fidelity Tax Sheltered Annuities. |
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| Health Care Flexible Spending Account Enrollment Form -This form is used to elect participation in the Health Care Flexible Spending Account. |
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| Health Care Flexible Spending Account Claim Form - This form is used to request reimbursement for eligible health care flexible spending account expenses. |
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| Kaiser Permanente Enrollment/Change Form - This form is completed by the employee who wishes to enroll in or make changes to Kaiser. |
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| Leave of Absence Form -This form is used by the employee to request a leave of absence. |
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| Long Term Disability Personal Health Application Form - This form is used to request evidence of insurability in the long term disability plan. |
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| Long Term Disability Enrollment/Change Form - This form is used to elect or cancel Long Term Disability coverage. |
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| Mutual of Omaha STD Enrollment Application - This form is used to enroll in the Mutual of Omaha STD plan. |
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| Mutual of Omaha STD Change Form - This form is used to make changes to an employee’s existing Mutual of Omaha STD plan. |
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| Optional Retirement Plan Election Form - This form is used to change ORP annuity contribution percentages. |
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| Salary Reduction Agreement - This form is used to authorize payroll deductions for tax sheltered annuities. |
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| Sick Pool Donation/Withdrawal
Form - This form is used to donate or withdraw sick leave to/from the Sick Leave Pool. |
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| Spectera Vision Enrollment Form - This form is used to enroll in or make changes to the vision plan. |
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| TIAA-CREF Enrollment Form -This form is used to enroll in TIAA-CREF Tax Sheltered Annuities. |
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| Tuition Assistance Program
(TAP) Form - This form is used by eligible employees to request educational assistance under TAP (formerly the Tuition Remission & Reimbursement (TRR) program). |
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| VALIC Enrollment Form -This form is used to enroll in VALIC Tax Sheltered Annuities. |
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| -- Employee Relations -- | ||
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| Laker Angels
Information and Release Form If you would like your home address shared with the Laker Angels upon request, please sign and return this form to the Human Resources office. |
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| -- Hiring Managers -- | ||
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| Position
Request Form This form is used to start the process of creating, reclassifying, refilling or modifying a position. |
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| Personnel Action Form This form is used by the manager to request personnel actions through the Office of Human Resources. |
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| Telephone Reference Checklist This form is used by hiring managers to summarize the provided references of applicants. |
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| Critical Personnel Request Form This form is used by the hiring manager to justify hiring of critical personnel during the hiring freeze. |
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| -- Worker Compensation-- | |
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| Coming Soon |
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| --Family & Medical Leave Act-- | ||
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| Family and Medical
Leave Request Form (FMLA) -This form is submitted by the employee stating that the request was approved by a Health Care Professional as eligible for FMLA leave. |
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| FMLA Healthcare
Provider Certification Form -This form is to be completed by the healthcare provider to certify an FMLA leave request. |
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| -- Performance Management -- | ||
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| Progressive Discipline
Form - This form is used by supervisors and managers to document progressive discipline of employees. |
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| Performance Appraisal Form
(Administrative - Director and above) -This form is used for appraising the performance of professional and administrative (monthly) employees. |
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| Performance Appraisal
Form (General Staff) -This form is used for appraising the performance of staff employees. |
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| Performance
Improvement Plan -This form is intended to summarize your current job performance and to provide a performance improvement plan. |
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| Performance
Improvement Plan - Supplement -This form offers supplemental information to assist in completing the Performance Improvement Plan. |
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| Self-Evaluation -This form is completed by the employee during the Performance Appraisal period. |
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| -- Payroll -- | ||
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| Direct Deposit Information -All Clayton State University (CSU) full-time and part-time employees are eligible for Direct Deposit. |
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| Direct Deposit Authorization
Form -Completed by employees who wish to sign up for direct deposit. A voided check or deposit slip is required to setup direct deposit. |
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| Georgia Defined Contribution
Plan Application for Membership - This form is user to enroll in the GA Defined Plan. Applies to temporary employees only. |
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| Georgia Defined Contribution
Plan Application for Refund -This form is used for requesting refund of contributions in the GA Defined Plan. Applies to temporary employees only. |
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| Retiree Direct Debit
Authorization
Form -This form is completed by the retirees to authorize CSU to debit funds to cover the cost of benefits. |
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| Sick Leave
Contribution/Withdrawal Request -This form is completed by CSU employees to donate leave hours to the pool or to request leave hours from the pool. |
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| SmartBodies Payroll
Deduction Request -This form is used to request payroll deduction of SmartBodies membership dues. |
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| Payroll Schedule 2007-2008 |
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