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. |
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 | To be used for all new and existing Positions. |
| Requisition Form-Faculty and Staff | |
| 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 |
|
|
Requisition Form - Faculty/Staff (Word) |
To recruit for an open position. |
| Forms for Faculty Search Committees | Faculty Search Committee Forms are housed on the Office of Faculty Recruitment web site. |
Payroll Forms (Questions: (585) 475-2381 or (585) 475-2382)
Forms related to Kronos Timekeeping, Additional Payments, Payroll Changes and Tax Deductions can be found at: http://finweb.rit.edu/controller/forms.html#payroll
