Forms Library
Forms can be downloaded in Microsoft Word or Adobe
Acrobat formats. The Acrobat plug-in is a
free download from Adobe.
Employment |
Compensation/Classification |
Benefits | Employee
Relations | Hiring
Managers
Worker Compensation
| Family & Medical Leave
Act | Performance
Management | Payroll
CSU Nondiscrimination and Anti-harassment Policy
CSU Employee Data Form
-This is form is completed form employees at the time of hire.
Form W-4: Employee's Withholding Allowance Certificate
-Employees are required to complete this form to designate
their dependents and tax withholdings.
Non Resident
Instructions for W-4
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.
I-9
-This meets the IRCA requirement of determining eligibility
to work in U.S. New employees must satisfy this requirement
within 72 hours.
Security Oath
-This is form is completed by regular employees at the time
of hire. It is mandated by the board of regents.
Authorization for Release - Standard Check
- Also known as Basic Criminal History Check authorization,
required for all new employees.
Exit Interview Form
-This form is completed by employees leaving the University
in order to provide confidential feedback to Human Resources
and University Administration.
Clearance of Campus Form
-This form is completed by employees who are leaving campus
and submitted to the Payroll Department for final action.
Employment Agreement Between Institutions
This form is used when an individual is working for two
institutions simultaneously. Must be completed and
approved before hire date.
Right to Know Form
All Clayton State University employees are required to take
online Right to Know (RTK) Training. This form is used to
record acknowledgement of this requirement.
Selective Service
Verification
Compensation / Classification
Position Description Form
This form is used for classification of new positions and
to assist managers in creating a job description.
Benefit Cost Estimate Worksheet
Request for Additional Staff Compensation
A.D.A. Physician's Assessment Form
For completion by physician of employee requesting accommodation under ADA.
Benefits At A Glance - 2010
Benefits Election Summary Sheet 2010
Blue Cross Blue Shield Enrollment Form
This form is completed by the employee who wishes to elect coverage in the BCBS PPO, Blue Choice HMO, and/or the HSA/PPO plan.
Blue Cross Blue Shield Change Form
This form is used by the employee to make changes to his/her existing BCBS PPO, Blue Choice HMO, HDHP, and/or BOR Indemnity Dental plan.
Blue Cross Blue Shield Cancellation Authorization Form
This form is used to cancel coverage in the BCBS PPO, Blue Choice HMO, HDHP, and/or the BOR Indemnity Dental plan.
Cigna Enrollment/Change Form
This form is used to enroll in or make changes to CIGNA’s life insurance plans.
Cigna Beneficiary Designation Form
This form is used to change beneficiary designations.
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.
Fidelity Enrollment Form
This form is used to enroll in Fidelity Tax Sheltered Annuities.
Flexible Spending “Change in Status” Form (Health and Dependent Care)
This form is used to request a change in election due to a mid-year qualified life event.
Flexible Spending (Health and Dependent Care) Enrollment Form - CY 2009
This form is used to enroll in the health care and/or dependent care programs
Flexible Spending (Health and Dependent Care) Enrollment Form - CY 2010
This form is used to enroll in the health care and/or dependent care programs
Kaiser Permanente Enrollment/Change Form
This form is completed by the employee who wishes to enroll in or make changes to Kaiser.
Leave of Absence Form
This form is used by the employee to request a leave of absence.
Long Term Disability Personal Health Application Form
This form is used to request evidence of insurability in the long term disability plan.
Long Term Disability Enrollment/Change Form
This form is used to elect or cancel Long Term Disability coverage.
MetLife Dental Enrollment/Change Form
This form is used to enroll in and/or make changes to the MetLife Dental plan.
The Harford STD Enrollment Application
This form is used to enroll in The Hartford STD plan.
Optional Retirement Plan Election Form
This form is used to change ORP annuity contribution percentages.
Retiree Direct Debit Authorization Form
This form is completed by retirees to authorize
ADP to debit funds to cover the cost of benefits.
Salary Reduction Agreement
This form is used to authorize payroll deductions for tax sheltered annuities.
Sick Pool Donation/Withdrawal Form
This form is used to donate or withdraw sick leave to/from the Sick Leave Pool.
TIAA-CREF Enrollment Form
This form is used to enroll in TIAA-CREF Tax Sheltered Annuities.
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).
United Healthcare (formerly Spectera) Vision Enrollment/Change Form
This form is used to enroll in or make changes to the vision plan.
VALIC Enrollment Form
This form is used to enroll in VALIC Tax Sheltered Annuities.
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.
Position Request Form
This form is used to start the process of creating, reclassifying,
refilling or modifying a position.
Personnel Action Form
This form is used by the manager to request personnel
actions through the Office of Human Resources.
Telephone Reference Checklist
This form is used by hiring managers to summarize the provided
references of applicants.
Critical Personnel Request Form
This form is used by the hiring manager to justify hiring of
critical personnel during the hiring freeze.
Job Description Form
This form is used to provide a complete and accurate job
description of all staff positions.
Family & Medical Leave Act
Family and Medical Leave Request Form (FMLA)
This form is used by the employee to request family and medical leave.
FMLA Employee Healthcare Provider Certification Form
This form should be completed by the healthcare provider to certify an employee’s serious health condition.
FMLA Family Member Healthcare Provider Certification Form
This form is to be completed by the healthcare provider to certify a
family members’s serious health condition.
FMLA Qualifying Exigency for Military Family Leave Certification Form
This form is to be completed by the employee to certify a qualifying exigency.
FMLA Servicemember Healthcare Provider Certification Form
This form is to be completed by the healthcare provider to certify a covered servicemember’s serious injury or illness.
Progressive Discipline Form
This form is used by supervisors and managers to document
progressive discipline of employees.
Performance Appraisal Form (Administrative - Director and above)
This form is used for appraising the performance of professional
and administrative (monthly) employees.
Performance Appraisal Form (General Staff)
This form is used for appraising the performance of staff
employees.
Performance Appraisal Form (Student Workers)
This form is used for appraising the performance of student
workers.
Performance Improvement Plan
This form is intended to summarize your current job
performance and to provide a performance improvement plan.
Performance Improvement Plan - Supplement
This form offers supplemental information to assist in
completing the Performance Improvement Plan.
Self-Evaluation
This form is completed by the employee during the Performance
Appraisal period.
Direct Deposit Information
All Clayton State University (CSU) full-time and part-time employees are eligible for Direct Deposit.
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.
Fitness Center Payroll Deduction Request
Georgia Defined Contribution Plan Application for Membership
This form is user to enroll in the GA Defined Plan. Applies
to temporary employees only.
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.
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.
Monthly Record of Leave & Other Absences
All monthly employees, full time faculty & 10 month faculty are required to complete this form on a monthly basis, even if no leave is taken.
Absence Report Form
This form is completed by the bi-weekly employee and his/her supervisor and records the use of sick and vacation time.
Payroll Schedule
2009-2010
