Human Resources Forms

Human Resources

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Human Resources Forms

The following categories of Human Resources forms are listed in the table below:

Miscellaneous Human Resources Forms
Hiring Process
EPMS / PD Forms
FMLA Forms
Benefits Forms
Payroll Forms
Orientation Forms

These forms are available in three different formats, as indicated by the icon in the Format column:

Adobe Acrobat®

Web page

Microsoft Word

Microsoft Excel

Please contact Latonia Allen to request additions/updates to this list.

Miscellaneous Human Resources Forms	Format	Policy Reference (If Applicable)
30 and 90 Meeting Form Template		N/A
2009 W-4 Employee Withholding Allowance Certificate		N/A
2009 W-5 Earned Income Credit Advancement Payment Certificate		N/A
Address Change (NetID Required)		N/A
ACORD Form (first report of injury)		Policy 27
ADA - Application for Reasonable Accommodation		Policy 24
AIDET Behavior Assessment		N/A
Benefit Exempt Employees (BEE) Agreement - Plan A
Benefit Exempt Employees (BEE) Agreement - Plan B
Benefit Exempt Employees (BEE) Agreement - Plan C
Benefit Exempt Employees (BEE) Agreement - Plan D
Bonus Pay		Policy 15
Certification Incentives
Certification Incentives Bonus (Effective January 2009)
Communication Slip for Separating Employees		Policy 39
Disciplinary Report		Policy 45
Education and Training Request Form
Emergency Data Form
Employee Physical Ability and Assessment (EPAA)		N/A
Hours/Status Change Letter		N/A
Leave Transfer Request		Policy 18
Orientation and Competency Guideline		Policy 5
Personnel File Review Guide		Policy 5
Personnel Records - Documentation Location		Policy 3
Physical Demands		Policy 4
PTO Cash-In/Conversion Form		Policy 18
PTO Donation		Policy 19
PTO Donation Request		Policy 19
Request for Leave		Policy 18
Request for Market Analysis		Policy 15
Secondary Employment and Certification		Policy 38
Secondary Employment Timesheet
Separation Notice		Policy 39
Standards of Behavior Committment Statement
Status Change Letter
Tuition Assistance Request Checklist		Policy 17
Tuition Assistance Request Form		Policy 17
Tuition Assistance Promissory Note		Policy 17
Unit File Destruction Form		Policy 3
Universal Name/Address Change Form
Work Weekend Option Form (WWO)
Work Weekend Option Program Guidelines
Exit Questionaire
Hiring Process	Format	Policy Reference (If Applicable)
PEAR		N/A

EPMS/PD (Employee Performance Management System/Position Description) - Should be used for Evaluations with Review Periods Beginning August 1, 2005, or later.	Format	Policy Reference (If Applicable)
Staff Evaluation Form FY2010		Policy 16
2007 Non-Management Employees		Policy 16
Administrator/Director (rev. 8/08) Plan I-A
Assistant Nurse Manager Plan II
Management Employees (rev. 8/08) Plan I-B
Coordinator Employees (rev. 8/08) Plan II		Policy 16
Educator
Medical Assistant
Medical Assistant (Certified or Registered)
MUSC Excellence Leader Evaluation
Patient Care Tech I		Policy 16
Patient Care Tech II		Policy 16
Register Nurse I (New Graduate)		Policy 16
Registered Nurse I Evaluation Criteria
Registered Nurse II		Policy 16
Registered Nurse II Evaluation Criteria
Registered Nurse III		Policy 16
Registered Nurse III Evaluation Criteria
Student Tech I		Policy 16
Student Tech II		Policy 16
Sitter
FMLA Forms (Family Medical Leave Act)	Format	Policy Reference (If Applicable)
FMLA - 1st Letter of Notification		Policy 30
FMLA - Childbirth / Adoption / Foster Care		Policy 30
FMLA - Employee's Serious or Chronic Health Condition		Policy 30
FMLA - Care for Employee's Seriously Ill Family Member		Policy 30
FMLA – Qualifying Exigency for Military		Policy 30
FMLA - Serious Injury or Illness of Covered Servicemember		Policy 30
Benefits Forms	Format	Policy Reference (If Applicable)
401K & 457 Contribution Form		N/A
401K & 457 Enrollment Form		N/A
403B Payroll Reduction Agreement		N/A
Blue Choice Claim Form		N/A
Certification Regarding Tobacco Use		N/A
Notice of Election (NOE)		N/A
State Health Plan - Health Expenses Claim Form		N/A
State Health Plan Prescription Drug Claim Form		N/A
State Health Plan Request for Health Insurance Card		N/A
CIGNA Health Expenses Claim Form		N/A
CIGNA Prescription Drug Claim Form		N/A
State Dental Plan Dental Claim Form		N/A
MoneyPlus Reimbursement Request Form		N/A
Payroll Forms	Format	Policy Reference (If Applicable)
Direct Deposit		N/A
Kronos Time Entry Form		Policy 29
Request for Correction of Leave Record		Policy 18
Special Payment Form
Supplemental Check Form
University Employee MUHA Weekly Time Record		N/A
Orientation Forms	Format	Policy Reference (If Applicable)
Clinical Employees Orientation Summary Sheet		N/A
Clinical Employees Performance Criteria		N/A
Non-Clinical Employees Orientation Summary Sheet		N/A
Non-Clinical Employees Performance Criteria		N/A

Page last updated:11/10/2009