Empowering a Community of Excellence

Documents & Forms

Document Type

1101A Employer's Report of Accident Form (pdf)

Form used by supervisors to report a work related accident to Human Resource Management.
Additional instructions

This form should be completed and submitted to Human Resource Management within 48 hours of the accident by emailing it to hrdept@ku.edu or by faxing it to 785-864-5790.

Form

30 Day Waiting Period Waiver Request Form (pdf) »

A form to waive the 30 day waiting period for coverage under the State Employee Health Plan (SEHP). This waiver is typically used when the prospective employee is required to have health insurance as a condition of obtaining a work visa for employment.
Additional instructions

Submit the completed form to the Benefits Office by either fax to 785-864-5200 or by campus mail to "Human Resources - Benefits".

Form

Accessing Funds for KBOR Mandatory Retirement Plan (pdf)

Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Advance Prescription Drug Purchase (pdf) »

Form

Affiliate Data Form (pdf)

This form is used to provide information to HRM to authenticate affiliate status.
Additional instructions

Please complete this form and submit it to Human Resource Management by fax to 785-864-5790 or by campus mail to "Human Resources - Appointment Specialists".

Form

AIG Cuba Travel Certification (pdf)

Form

Basic Group Life Insurance - Designation of Beneficiary Form for KBOR Retirement Plan Participants (pdf) »

This form designates a beneficiary for life insurance benefits for participants in the KBOR retirement plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Basic Group Life Insurance - Designation of Beneficiary Form for KPERS Retirement Plan Participants (pdf) »

This form designates a beneficiary for life insurance benefits for participants in the KPERS retirement plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Class Observation Template for GTAs (doc)

Form

Continuation Enrollment Form for GTA/GRA/GA and dependents (pdf)

United Healthcare Continuation Enrollment Form for GTA/GRA/GA and dependents from August 1, 2016 through July 31, 2017
Form

DEA Lab Conviction Check Form (doc)

Complete this form if you are required to undergo a criminal conviction check for access to DEA registered labs.
Form

Direct Deposit Authorization of Employee Pay (pdf)

Authorizes your financial institution to receive and deposit your bi-weekly pay check.
Form

Director Evaluation Form (doc)

This form is used as a template for evaluating performance for a director level employee.
Form

Employee Data Sheet (pdf)

Provides key employee information required for the HR/Pay system.
Form

Employee Eligibility Verification (I-9) (pdf)

Verifies the identity and employment authorization of the new employee.
Form

Employee Feedback Form for USS (docx)

Supervisors are required to provide USS employees with the Employee Feedback Form and encourage employees to provide personal input. It is optional for the employee to provide personal feedback; however, the employee must indicate that the opportunity was offered with the check box near the "Goal/Job Objective Achievement" section
Form

Employee Invention Assignment Agreement (pdf)

The purpose of this form is to indicate that you have read the Employee Invention Assignment Agreement and agree to its provisions throughout your employment with KU.
Form

Employee of the Month - Paper Nomination Form (pdf)

Paper form for nominating an employee for the Employee of the Month award.
Form

Flex Time Agreement Form (doc)

Required form for employees interested in applying for a flex-time schedule.
Form

FMLA - Certification of Health Care Provider for Family Member’s Serious Health Condition (pdf)

Certification form to be completed by the employee and the patient’s healthcare provider to support a request for FMLA leave to care for a covered family member with a serious health condition.
Additional instructions

 Return this form and any required documentation within 15 calendar days by email to hrdept@ku.edu or by fax to 785-864-5790.

Form

FMLA - Employee’s Serious Health Condition Certification of Health Care Provider Form (pdf)

Certification form to be completed by the employee and the employee's healthcare provider to support a request for FMLA to treat a serious health condition that an employee is experiencing.
Additional instructions

 Return this form and any required documentation within 15 calendar days by email to hrdept@ku.edu or by fax to 785-864-5790.

Form

FMLA - Illness of Covered Service Member for Military Family Leave Certification for Serious Injury (pdf)

Certification form to be completed by the employee and an authorized healthcare provider to support a request for FMLA leave due to a serious injury or illness of a covered service member.
Additional instructions

 Return this form and any required documentation within 15 calendar days by email to hrdept@ku.edu or by fax to 785-864-5790.

Form

FMLA - Military Family Leave Certification of Qualifying Exigency (pdf)

Certification form to be completed by the employee to support a request for FMLA leave due to a qualifying exigency related to a family member who is called to active duty by the U.S. Military.
Additional instructions

 Return this form and any required documentation within 15 calendar days by email to hrdept@ku.edu or by fax to 785-864-5790.

Form

Formal Accommodation Form (pdf)

Formal Accommodation Form for employees to complete
Form

Goals/Objective Setting Form for USS (docx)

This is the goals/objective setting form used by USS employees.
Form

Graduate Research Assistant (GRA) Intent to Appoint (pdf)

Form

Grievance Form for 1290PE Covered Employees (pdf)

This form is for employees electing to use the 1290PE MOA grievance process. Additional sheets may be attached if additional space is needed. All attachments must be dated, signed, and identify the specific step to which each attachment applies.
Form

Grievance Form for USS Employees (xls)

USS employees should use this form to initiate the grievance process.
Additional instructions

The original form should be submitted to your immediate supervisor and a copy should be sent to Human Resource Management by email to hrdept@ku.edu or by fax to 785-864-5790, no later than 10 working days from the date of the grievable act or the date when you knew or should have known of the grievable act. Please note that failure to submit the form by this deadline may jeopardize your right to proceed with your grievance.

Form

GSHI continuation insurance application 2017/2018 (document)

Form

Health Care Selection Form (TEFRA) (pdf) »

Form

Health Plan Communication Form

To communicate concerns, suggestions or requests concerning the SEHP, please complete the Health Plan Communication Form and upload the Communication Form into MAP (the Membership Administration Portal) and the form will be submitted to the State Employee Health Plan. If you need assistance, contact the Benefits Office at 864-4946 or email benefits@ku.edu.
Form

HR/Pay PeopleSoft & DEMIS Shared Service Access Form (excel)

This form if for Shared Service Center (SSC) staff to gain access to HR/Pay and DEMIS systems. Please submit to hrpay@ku.edu.
Form

Injured Worker’s First Fill Prescription Form (pdf)

This form will allow you to fill approved medications related to your workers’ compensation claim. It should be presented along with your prescription to your local network pharmacy.
Form

Investment Agreement for KBOR Mandatory Retirement Plan (pdf)

Form used to elect your KBOR Mandatory Retirement Plan investment provider.
Additional instructions

Submit the completed form to the Benefits Office by either fax to 785-864-5200 or by campus mail to "Human Resources - Benefits"

 

Form

K-4 – Kansas Withholding Allowance Certificate (pdf)

Identifies the number of personal withholding allowances for year-end federal tax calculations. Please note – specific instructions for international employees may apply.
Form

KBOR Retirement Data Form (pdf)

Complete this form to enroll in the KBOR Retirement Plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

KBOR Retirement Verification Waiver Form (pdf)

Form that is to be completed if you are eligible to waive the required one-year waiting period and apply for immediate participation in the KBOR Mandatory Retirement Plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

KPERS Application to Purchase Service Credit (pdf) »

This form is to be completed by active KPERS members who are applying to purchase service credit.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

KPERS Retirement Data Form (pdf)

Complete this form to enroll in the KPERS Retirement Plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

KU ID Card Acknowledgement (docx)

Allows new employees the option to have their KU Card delivered via campus mail or in person.
Form

Language Proficiency Verification for Prospective Faculty Form (pdf)

This form is intended for use with prospective faculty whose first language is not English and must be submitted with the Approval for Written Offer Form.
Form

Manager Evaluation (doc)

This template is narrative based and has a rating scale for evaluating performance at the manager level.
Form

Materials retention cover sheet (pdf)

Units who wish to use the imaging service only need to complete the Materials Retention Cover Sheet (PDF) and forward this with their search materials to their SSC contact in a confidential envelope.
Form

Medical Accommodation Form (pdf)

Medical form for employee/doctor to complete
Form

Medical Document Form (pdf)

Form used to submit medical documents for accommodations
Form

New Employee Packet - All Hiring Forms (pdf)

A single pdf containing all of the required forms from the New Employee Packet.
Form

Optional Group Life Insurance Enrollment Form (pdf) »

Form that must be completed and returned to Human Resource Management within 21 days of your hire date to enroll in the KPERS Optional Group Life Insurance plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Optional Group Life Insurance Reduction/Cancelation Form (pdf) »

Employees who are currently enrolled in the optional group life insurance program complete this form if they wish to reduce or cancel their current coverage.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Performance Evaluation Form for USS (docx)

This is the form that supervisors should use to evaluate USS employee performance.
Form

Performance Evaluation Template for GTAs (doc)

Form

Performance Evaluation Template for Student Hourly Employees (xls)

Form

Performance Rating Appeals Form for USS (pdf)

Form used by regular USS employees who want to appeal an evaluation rating. This can be submitted up to 7 calendar days after signing the evaluation. Please submit this form to HRM for review.
Form

Project SEARCH Inquiry Form (webform)

Units that are interested in becoming a Project SEARCH internship site should complete this form. Once submitted, HRM will review your request and contact you regarding next steps.
Form

Reference Release Form (pdf)

Form to authorize HR to provide work related references to off-campus employers.
Form

Request for Disciplinary Action (pdf)

Form used to request HRM take suspension, dismissal, or demotion type disciplinary actions related to USS employees.
Form

Sample Reference Questions (pdf)

Sample reference questions that can be used during the candidate interview process.
Form

Screening tool for faculty and staff (excel)

"Instructions: -Complete Applicant Screening section (Blue) for each candidate. -Complete Interview Evaluation section (Green) for each candidate interviewed. -Provide reasoning interviewed candidates were not hired in the last column (Salmon). -Complete yellow section to provide information on candidate(s) selected for hire. -Return Screening Summary to your HR-ROC representatives."
Form

Self Evaluation Template for GTAs (doc)

Form

Shared Leave Donation Form (excel)

This form is used by faculty/staff to donate sick and/or vacation leave to a qualified faculty/staff member who is out of leave (or nearly out of leave) and experiencing (or caring for a family member who is experiencing) a serious, extreme or life threatening illness or injury.
Additional instructions

Submit this form to Human Resources by fax to 785-864-5790 or by email to hrdept@ku.edu.

Form

Shared Leave Request Form (pdf)

Faculty/staff who are out of (or nearly out of) leave and have (or are caring for a family member who has) a serious, extreme, or life-threatening injury or illness use this form to apply for shared leave.
Additional instructions

Submit this form to Human Resources by fax to 785-864-5790 or by email to hrdept@ku.edu.

Form

Staff Paid Time Release Request (pdf)

Staff/departments may use this form as an option to request/review paid release time from job duties during work shift; retain in department for 3 years.
Form

State of Kansas Agency Employment Form (pdf)

The purpose of this form is to indicate if you have ever been employed at the University of Kansas of other State of Kansas Agencies.
Form

State of Kansas Employee Oath and University Policy Acknowledgement (pdf)

The purpose of this form is to complete the State of Kansas Oath and to indicate that you have read and agree to follow the specific university policies throughout your employment with KU.
Form

State of Kansas Substance Abuse Policy Affirmation Form (pdf)

Acknowledges that you have read the State of KS Substance Abuse Policy and agree to its provisions throughout your employment.
Form

State of Kansas Tax Clearance Information Form (pdf)

Acknowledges your understanding and expectations to fulfill your responsibility to pay your share of Kansas state taxes.
Form

Student Hiring Summary (docx)

• Complete Hiring Summary for all students you are hiring for the position listed and return to your HR ROC representatives. • All other applicants will be marked as “Not Hired” and receive an e-mail notification regarding their application status.
Form

Student Hourly Special Rate Request (doc)

For use when requesting to pay a student hourly employee more than $15/hour.
Additional instructions

Form may be sent to HR by email (hrdept@ku.edu), fax (785-864-5299) or mailed to 103 Carruth-O'Leary Hall.

Form

Supervisor Evaluation Form (doc)

This form is used to evaluate supervisors. It contains clear and detailed instructions on how to complete the form and areas to provide comments and feedback.
Form

Supervisor Update Form (excel)

Form

Unclassified Self Assessment Template 1 (doc)

Detailed UPS self assessment template with accomplishments, competency review, strengths and improvements, and improvement plan.
Form

Unclassified Self Assessment Template 2 (doc)

Narrative based template with accomplishments and goals and strengths and improvements for UPS self assessments.
Form

Unclassified Staff Evaluation Template 1 (doc)

Narrative based template for unclassified staff evaluations.
Form

Unclassified Staff Evaluation Template 2 (doc)

Detailed template with instructions and guidelines on how to use the form for unclassified staff evaluations.
Form

Unclassified Staff Evaluation Template 3 (doc)

Detailed UPS self assessment template focusing on University Core Competencies.
Form

Voluntary Leave Without Pay Request Form (pdf)

Submit this form to your supervisor to begin the voluntary leave without pay request process.
Additional instructions

Submit this form to Human Resources by fax to 785-864-5790 or by email to hrdept@ku.edu.

Form

Voluntary Leave Without Pay with Benefits optional worksheet (excel) (document)

Form

Voluntary Retirement Plan - 403(b) Funds Access Form (pdf)

Complete this form if a triggering event has occurred, and you need to request access to your 403(b) funds and you are NOT able to access your account using planwithease.com.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Voluntary Retirement Plan - Pre-tax Salary Reduction Authorization Form (pdf)

Form used to authorize KU to reduce your salary for pre-tax contributions to the Voluntary Retirement Plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Voluntary Retirement Plan - Roth After-tax Salary Reduction Authorization Form (pdf)

Form used to authorize KU to reduce your salary for after-tax contributions to the Voluntary Retirement Plan.
Additional instructions

Submit the completed form to the Benefits office using one of the following methods:

  • Fax the form to 785-864-5200.
  • Send it by campus mail to “Human Resources – Benefits”.
Form

Voluntary Self Identification of Disability (pdf)

This form is voluntary to disclose disability status. A glossary of terms used on this form is available here.
Form

Volunteer Form (pdf)

This form is to provide information to HRM to authenticate volunteer status.
Form

W-4 - Federal Withholding Authorization (pdf)

Identifies the number of personal withholding allowances for year-end federal tax calculations. Please note – specific instructions for international employees may apply.
Form

WC-9 Injured Employee's Report of Injury (pdf)

Form

Written Reprimand for 1290PE Covered Employees (pdf)

Form used by supervisors to document a written reprimand for 1290PE covered employees.
Form

Need Help? Ask Us!
JavaScript disabled or chat unavailable.
Search for HRM Policies
 

Visit the Policy Office for more information.

HRM Calendars
Coming Soon
Coming Soon
KU Today