RIT
Human Resources

Forms

Here you will find forms that can save you a trip to HR. All forms that are in a PDF format require Adobe Acrobat Reader, version 4 or higher, on your computer (MAC or PC). To download this free software visit http://www.adobe.com/products/acrobat/readstep2.html and follow the instructions.

Benefits (Questions: (585) 475-2424/v, (585) 475-2420/tty)

Form Name Use
Accident Report Form To report an accident or injury that occurs at work
Adoption Assistance Program Reimbursement Form To request reimbursement for eligible adoption expenses.
Affidavit of Domestic Partnership To certify your domestic partner relationship.
Application for Domestic Partnership Benefits To enroll, change, or cancel benefits for your domestic partner.
Beneflex Authorization to Release Protected Health Information (PHI) To provide your authorization to EBS to release your PHI to another person(s) or entity (PHI includes information regarding your account and your claims).
Beneflex Data Change Form To update EBS with new information (e.g., address change)
Beneficiary Designation Form To designation a beneficiary for your Basic and Supplemental Life Insurance.
Beneflex Direct Deposit Form To sign up, change or cancel direct deposit of Beneflex reimbursements.
Beneflex Reimbursement(FSA) To claim Beneflex reimbursement.
Beneflex Request Form for Additional EBS Flex Card To request an additional Flex Card for a family member.
Dental Claim Form To submit dental claims to the dental plan administrator.
Enrollment for Dependent Student To continue medical/dental coverage for child who is a full-time college student.
Evidence of Insurability Form To obtain insurance company's approval for life and/or disability insurance.
Job-Related Verification Form To apply for tax waiver for graduate courses taken by RIT employees.
Medical Claim Form To submit medical services claim for reimbursement to Excellus BlueCross BlueShield
Prescription Drug Reimbursement To submit prescription drug claim for reimbursement to Medco
Retirement Plan Before-Tax Salary Reduction Agreement. To authorize contributions from your paycheck to the Basic and Voluntary Retirement Plan.
Retirement Transition Program Request Memo To request participation in Retirement Transition Program.
RIT Benefits Enrollment/Change Form To enroll, change, or cancel most RIT benefits.
RIT Health Care Enrollment/Change Form To enroll, change, or cancel medical and/or dental insurance coverage.
Statement of Termination of Domestic Partnership To terminate the Affidavit of Domestic Partnership.
Tuition Assistance To apply for reimbursement for job-related courses you take at accredited colleges and universities and to apply for department funding for CPD courses.
Tuition Exchange Application and Recertification To apply for or recertify eligibility for the Tuition Exchange benefit.
Tuition Scholarship To apply for reimbursement for undergraduate tuition at other accredited colleges/universities for eligible children.
Tuition Waiver Form For regular employees to cover spouse/domestic partner and children for courses taken through LDC and the English Learning Center; for adjunct employees and eligible non-employees (e.g., ROTC) to cover spouse/domestic partner and children under RIT's Tuition Waiver Program for credit-bearing courses.
Tuition Waiver Benefit Form - Family Member Information For regular employees to cover spouse/domestic partner and children under RIT's Tuition Waiver Program for credit-bearing courses.
Vacation Carry-Over Form for Exempt Employees For exempt employees to carry vacation time over from fiscal year 2008-09 to fiscal year 2009-2010.

Employment (Questions: (585) 475-2424/v, (585) 475-2420/tty)

Form Name Use
General Employment Forms
Background Check Authorization To grant permission for a criminal background and or mvr check to be performed.
Background Check: Notice of Rights Under the Fair Credit Reporting Act
Disability-Related Accommodations Request For faculty and staff to request disability-related accommodations in the workplace.
Employee Change of Personal Information To change name, address, phone number, or emergency contact information.
Employment Application Form - Resume Provided It is strongly recommended that you use our automated job application system https://mycareer.rit.edu to apply for positions at RIT. If you are unable to do so, you may fill out this form and return it to the Human Resources Department.
Employment Application Form - Without Resume It is strongly recommended that you use our automated job application system https://mycareer.rit.edu to apply for positions at RIT. If you are unable to do so, you may fill out this form and return it to the Human Resources Department.
iRecruitment Security Request Form Use this form to request access to the RIT iRecruitment Manager responsibility in Oracle
Job Description Questionnaire (Word ) To be used for all new and existing Positions.
Requisition Form-Faculty and Staff
Sample Candidate Tracking Form
Word
To track interviewees.
Staff Performance Appraisal Procedures and Forms To initiate and conduct staff performance appraisals and/or upward appraisal.
Termination Checklist To ensure all necessary actions are completed before and after employee terminates.
Worksheet - Grant Funded Positions To calculate account breakdowns for grant funded positions.
Worksheet - Summer Salary To calculate summer salary for regular employees.
Employee Action Forms
Adjunct Rehire - EAF To re-hire a previous RIT adjunct faculty.
Adjunct/Overload/Special Assignment - EAF (Word) To initiate Adjunct new hire, or Overload for Adjunct faculty or Special Assignment action for RIT faculty or staff.
Leave of Absence - EAF (Word) To initiate leave of absence action for RIT faculty or staff.
New Hire - EAF (Word) To initiate new hire action for RIT faculty and staff employees.
Salary Redistribution - EAF (Word) To initiate salary restribution for RIT faculty and staff employees.
Summer Salary - EAF (Word) To initiate summer hire action for RIT faculty.
Summer Salary Grants and Contracts - EAF To initiate summer hire action for RIT faculty.
Termination - EAF (Word) To initiate termination of employment action for RIT faculty and staff employees.
Transfer/Promotion/Other - EAF (Word) To initiate, transfer, or promotion action for RIT faculty and staff employees.
Faculty Forms
Offer Letter Template - Faculty To provide required and optional language for dean's offer letters to new faculty.
Faculty Position Posting Form updated 12/08 To post faculty positions to Career Zone and HigherEdJobs.com send this form electronically.
Pre-Offer Summary Form - Faculty updated 1/08 For search committee to give final recommendations to hire for faculty position.
Recruitment Plan Form - Faculty To record search committee recruitment plans and efforts.
Requisition Form - Faculty/Staff
(Word)
To recruit for an open position.
Faculty Search Process Checklist - Faculty updated 12/07 Resource for search committees to follow for when and what needs to be checked in with Office of Faculty Recruitment.
Search Waiver Request - Faculty Authorization needed to fill a faculty position without conducting a formal search.
Faculty Selection Criteria Rating Template Form updated 7/08 Editable template to track applicants.

Payroll (Questions: (585) 475-2381 or (585) 475-2382)

Form Name Use
Additional Payment Form To process payments to employees for work over and above base salary.
Blank Timecard The RIT Time sheet.
Dining Services Tiger Bucks To set up payroll deductions for RIT Tiger Bucks debit account.
Direct Deposit Form To sign up, change or cancel direct deposit of payroll check.
Federal Form W-4 go to www.rit.edu/myinfo to update your information online To claim federal tax exemptions.
Kronos Security Access Form To set up Kronos departmental users in Kronos Automated Time and Attendance System.
Margaret's House Deduction Form To set up or cancel payroll deductions for Margaret's House.
NY IT-2104 To claim New York State tax exemptions.
Payroll Change Form To initiate any payroll adjustments for earnings or pay codes for a prior pay-period.
Reserved Parking Salary Reduction Authorization To authorize pre-tax salary deduction from your paycheck for the purchase of an RIT Reserved Parking Permit
Timecard Change Form When adding a punch, or changing an existing punch in a CURRENT pay period.