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. To download this free software visit http://get.adobe.com/reader/ and follow the instructions.

You can use Ctrl-F to search within this page.

For assistance, please call the main Human Resources number at (585) 475-2424 or refer to the HR Staff Directory.

The forms below are grouped into the following sections:

 

Benefits Forms

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.

Benefits Enrollment/Change Form

To enroll, change, or cancel most RIT benefits.

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)

Beneflex Direct Deposit Form

To sign up, change or cancel direct deposit of Beneflex reimbursements.

Beneflex Reimbursement (FSA) – Dependent Day Care Spending Account

To claim Beneflex dependent day care spending account reimbursements.

Beneflex Reimbursement (FSA) - Health Care Spending Account

To claim Beneflex health care spending account reimbursements.

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.

Job-Related Verification Form

To apply for tax waiver for graduate courses taken by RIT employees.

Life Insurance Evidence of Insurability Form To apply for an increase in life insurance and/or Supplemental Long Term Disability coverage.

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 Transition Program Request Memo

To request participation in Retirement Transition Program.

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 the Academic Supports Center and the English Learning Center; for adjunct employees and eligible non-employees (e.g., ROTC) to cover themselves or 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.

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

 

Cost Account Calculation Worksheet-Grant Funded Positions

To calculate account breakdowns for grant funded positions.

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

It is strongly recommended that you use our automated job application system http://careers.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.

New Hire Personal Data Form

New faculty and staff hires will need to complete this form along with their other new hire paperwork.

New York State LENS Program MVR Form

Enrollment into New York LENS Program

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.

Transfer Checklist

The previous manager should complete this checklist when a faculty or staff member in their department is being hired into another department at RIT

Worksheet - Summer Salary

To calculate summer salary for regular employees.

Job Evaluation and Position Control Forms

Visit the Position Control Website for Additional Information on Processing Position Changes (there is no longer a position change form)

Job Description Questionnaire

To be used for all new and existing Positions.

Job Description Questionnaire Instructions

New PC Number Setup Form

Use this form to request a PC number to be used in an incremental requisition form in Career Zone

Re-organization/Organization Name Change Template (Excel)

To initiate a department re-organization or organization name change.

Employee Action Forms

Faculty Employee Action Forms

Faculty - Hire

All hires on a requisition in Career Zone should be processed using the online EAF form in the Career Zone system. Consult the Career Zone user guide for instructions.

Faculty - Leave Start

To initiate a leave of absence RIT faculty

Faculty - Leave Return

To initiate a return to work action for RIT faculty

Faculty - Salary Redistribution

To initiate salary redistribution/costing change for RIT faculty

Faculty - Assignment, Job or Salary Change

To initiate a change transaction on the employee's assignment, job or salary. Please refer to the back of the form for further information.

Lecturer - Term Change

To be used to change or renew a multiple year term period of appointment for a Lecturer, Senior Lecturer or Principal Lecturer.

Summer Salary Grants and Contracts - EAF

To initiate summer hire action for RIT faculty on grants and contracts.

Summer Salary - EAF

To initiate summer hire action for RIT faculty not on grants and contracts.

Faculty - Termination

To initiate termination of employment for RIT faculty

Faculty Overload

To initiate Faculty Overload Pay Action for an appointment within the employee's own college outside of their plan of work

Faculty Special Assignment

To initiate Special Assignment Pay Action for RIT regular Faculty employees

Transfer Checklist

The previous manager should complete this checklist when a faculty or staff member in their department is being hired into another department at RIT

FTE Calculator

Excel spreadsheet to be used for calculating employee FTE based upon their standard months, weeks, hours

Staff Employee Action Forms

Staff - Hire

All hires on a requisition in Career Zone should be processed using the online EAF form in the Career Zone system. Consult the Career Zone user guide for instructions.

Staff - Leave Start

To initiate a leave of absence RIT staff

Staff - Leave Return

To initiate a return to work action for RIT staff

Staff - Salary Redistribution

To initiate salary redistribution for RIT staff

Staff - Assignment, Job or Salary Change

To initiate a change transaction on the employee's assignment, job or salary. Please refer to the back of the form for further information.

Staff - Termination

To initiate termination of employment for RIT staff

Staff Special Assignment

To initiate Special Assignment Pay Action for Exempt Staff Employees for a period of time outside of the normal quarter time frame.

Transfer Checklist

The previous manager should complete this checklist when a faculty or staff member in their department is being hired into another department at RIT

FTE Calculator

Excel spreadsheet to be used for calculating employee FTE based upon their standard months, weeks, hours

Adjunct Employee Action Forms

 

 

Adjunct New Hire

To initiate hire action for new Adjunct employees. Exempt Adjunct only

Adjunct - Termination

To initiate termination of employment for RIT Adjunct when the Adjunct is leaving RIT permanently

Adjunct Non-Exempt Hire/Rehire

To initiate a hire or rehire of a non-exempt (hourly) adjunct. Use only for hiring existing RIT non-exempt employees. Refer to instructions on back of form

Recruitment Related Forms

Faculty Posting Form

 

Faculty Mid Search Review Form

 

Faculty Search Process Checklist

 

Selection Criteria Rating Form

 

Career Zone Online Requisition (there is no longer a paper requisition form)

If you already have a position control number, go directly to http://careers.rit.edu/managers to create your online requisition.  If you need a pc number to use in your requisition, you must first complete the New PC Number Setup form .  HR will then assign you a number to use in the online requisition in Career Zone.

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://www.rit.edu/fa/controller/forms.html