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. |
| 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. |
| FMLA Health Authorization – Employee’s own health condition | Provides authorization to contact health care provider. |
| FMLA Health Authorization – Family Member | Provides authorization to contact health care provider. |
| 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 |
| Notice And Proof of Claim for Disability Benefits | To apply for short-term disability benefits. |
| 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. |
| Rochester Optical Protection Assured PLUS Application | To apply for Rochester Optical Protection Assured PLUS program. |
| Sick Time Cashout Information and Form | |
| 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. |
Employment (Questions: (585) 475-2424/v, (585) 475-2420/tty)
| Form Name | Use |
|---|
General Employment Forms |
|
| Affirmative Action Recruitment & Hiring Documentation | To recruit & hire employees. |
| Background Check Authorization | To grant permission for a criminal background and or mvr check to be performed. |
| 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 | To formally become an applicant for employment at the university. Use this form to apply for employment at the university ONLY IF you are unable to access and use our job application site at https://mycareer.rit.edu |
| Employment Application Form - Without Resume | To formally become an applicant for employment at the university. Use this form to apply for employment at the university ONLY IF you are unable to access and use our job application site at https://mycareer.rit.edu |
| Interpreter Pay Advance Opt In | |
| iRecruitment Security Request Form | |
| 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 - Online | 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 (Word) | 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 |
|
| Future Faculty Career Exploration Program Application Form | To apply for the Future Faculty Career Exploration Program. |
| Offer Letter Template - Faculty | To provide required and optional language for dean's offer letters to new faculty. |
| Position Posting Form - Faculty updated 10/07 | To post faculty positions to Career Zone and HigherEdJobs.com send this form electronically. |
| Pre-Offer Summary Form - Faculty | 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. |
| Search Process Checklist - Faculty updated 10/07 | 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. |
| Selection Criteria Rating Sheet - Faculty | 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. |
| 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. |
| Food Service Debit | To set up payroll deductions for RIT debit card. |
| Kronos Employee Setup Form | To set up employees in Kronos Automated Time and Attendance System. |
| 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. |