Forms for Current Employees
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Contact Info
All forms are PDFs unless otherwise noted.
Insurance
Initial Benefits Enrollment for New Employees
- My UT Benefits online enrollment system
- Long Term Care Enrollment
Review New Employee Benefits Enrollment Checklist for more information
Mid-Year Change in Status Events
- Insurance Enrollment/Change Application
- Dependent Information
- Proof of Relationship Cover Sheet
- Beneficiary Designation for Term Life and AD&D
- Long Term Care Enrollment
- Dependent Grandchild Certification Form
- Application for Term Life and Short/Long Term Disability
COBRA Continuation Coverage
Insurance Cost
- Benefit Cost Worksheet 2012-2013
Medical/Prescription
- Medco Prescription Drug Program At A Glance [PDF]
- UT Select Medical Claim
- UT Select Medco Pharmacy Order Form
- UT Select Prescription Claim
Dental
Vision
UT Flex
Time Off
- FML Certification of Healthcare Provider Form
- FML Certification for Qualifying Exigency Leave
- FML Certification for Military Family Leave
- Release to Return to Work
- 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
- Criminal Background Check Form
- Form I-9, Employment Eligibility Verification
- State Service Transfer Request
- Telecommuting Agreement
Appointments at EAP (Employee Assistance Program)
- EAP Confidentiality and Consent Information
- EAP Notice of Privacy Practices
- EAP Client Information
- EAP Non-Employee Client Information
- EAP Manager Information
Fitness for Duty
Workers' Compensation
- First Report of Incident-Injury Memorandum
- Workers’ Compensation Network Acknowledgement Form (English)
- Workers' Compensation Notice of Network Requirements (English)
- Workers’ Compensation Network Acknowledgement Form (Spanish)
- Workers' Compensation Notice of Network Requirements (Spanish)
Other
- CPR/AED Training Payment Form
- FERPA Authorization to Release Student Employment Records
- Flexible Work Arrangement/Work From Home Request
- New Employee Checklist
- Official Time Report
- Performance Appraisal
[PDF]
- Performance Appraisal [Word document]
- Employee Self-Appraisal Form [PDF]
- Employee Self-Appraisal Form [Word document]
- President's Exemplary Service Award Nomination Form
- Staff Emergency Fund Application
- Time Report for Hourly Employees
