• New Employees
• Career Management
• Time Off
• Insurance
• UTemps
• Compensation
• Retirement Programs
• Employee Services
• Compliance
• Forms

Forms for Current Employees

All forms are PDFs unless otherwise noted. PDFs require the free Adobe® Reader® or compatible software.

Insurance

Enrollment/Change

• Insurance Enrollment/Change Application
• Dependent Information
• Beneficiary Designation for Term Life and AD&D
• UT Flex Enrollment
• Long Term Care Enrollment (password:  utsguest)
• COBRA/Conversion Application Request

Evidence of Insurability

• Medical/Term Life Application
• Short/Long Term Disability Application

Insurance Cost

• Benefit Cost Worksheet 2009-2010
  • Interactive
  • Printable

Medical/Prescription

• Medco Prescription Drug Program At A Glance
• UT Select Medical Claim
• UT Select Medco Pharmacy Order Form
• UT Select Prescription Claim

Dental

• Assurant Primary Family Dentist Selection Form
• UT Select Dental (Delta) Claim Form

Vision

• Provider Nomination Form

UT Flex

• UT Flex Claim Form
• UT Flex Direct Deposit Authorization
• UT Flex Letter of Medical Necessity

Time Off

• FML Certification of Healthcare Provider Employee's Own Serious Health Condition
• FML Certification of Healthcare Provider Family Member's Own Serious Health Condition
• FML Certification for Qualifying Exigency Leave
• FML Certification for Military Family Leave
• Request for Sick Leave Pool
• Request for Family and Medical Leave
• Sick Leave Pool Certification of Health Care Provider
• Leave of Absence Request
• Sick Leave Pool Donation

Compliance

• Annual Request For Oustide Employment (Faculty/Research Staff)
• Annual Request For Outside Employment (Staff) New! Change in Review Process
• Applicant ID Verification
• Background Check Authorization for Faculty and Staff (Security Sensitive Form)
• Background Check Authorization for Affiliated Personnel (Security Sensitive Form)
• Employee Information
• Ethics Statement — English, Español
• Form I-9, Employment Eligibility Verification
• Selective Service Eligibility and Verification
• State Service Transfer Request
• Telecommuting Agreement New! Change in Review Process
• Veteran Status Information

Appointments at EAP

• Employee Assistance Program Confidentiality Information
• Employee Assistance Client Information
• Employee Assistance Non-Employee Client Information
• Employee Assistance Manager Information
• Work/Life Services & EAP Survey

Fitness for Duty

• Notification of Fitness for Duty Evaluation Procedure
• Certification of Fitness for Duty

Other

• FERPA Authorization to Release Student Employment Records
• Employee Separation Form
• Ethnicity and Race Re-identification Form
• Exemplary Service Award Nomination
• Flexible Work Arrangement/Work From Home Request
• New Employee Checklist
• Official Time Report
• Performance Appraisal [PDF]
  • Performance Appraisal [Word document]
• Staff Emergency Fund Application
• Time Report for Hourly Employees
• Worker's Compensation Request for Paid Leave

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