Personal Data Sheet (PDF)

W-4 Employee's Withholding Allowance Certificate (PDF)

IT-2104 Employee's Withholding Allowance Certificate New York State, NYC and Yonkers (PDF)

IT-2104.1 Employee's Withholding Allowance Certificate of Non-Residence (PDF)

Direct Deposit Authorization Form (PDF)

Post Offer Veteran Survey Form (PDF)

Statement of Computer Usage (PDF)

Affirmative Action Form (PDF)

I-9 Employment Eligibility Verification Form (PDF)

I-9 Instructions (PDF)

Institutional Policies and Procedures Manual

Statement of Domestic Partnership

Statement of Domestic Partnership (PDF)

Dental Care Plans (Delta Dental)

PPO Plan Reimbursement Claim Form (PDF)

Flexible Spending Accounts (EBPA)

Dependent Care Claim Form (PDF)

Health Care Claim Form (PDF)

EBPA Direct Deposit Form (PDF)

FSA Benefits Card Request Form (PDF)

Health Care Plan

UnitedHealthcare Claim Form (PDF)
Policy # 752051
Address: P.O. Box 740800, Atlanta, GA 30374

UnitedHealthcare Claim Form For Mental health Services Only (PDF)

Health Saving Account Application (PDF) for High Deductible Health Plan enrollees only

UnitedHealthcare Vision Plan

Contact Lens Formulary List In-Network Benefits (PDF)

UnitedHealthcare Vision Out-of-Network Reimbursement Claim Form (PDF)

Prescription Drug Coverage

Optum Rx Prescription Home Delivery Mail Order Form (PDF)

Long Term Care Information

Long Term Planning Associates (PDF)

Qualified Transportation Expenses Plan

Direct Deposit Form (PDF)

Reimbursement Claim Form (PDF)

Plan Summary (PDF)

Tuition Waiver Application

Tuition Waiver Form for Full-time Faculty and Non-Union Staff (PDF)

Tuition Waiver Request Form for PT Faculty Members (PDF)

Local 94/1205/32BJ Tuition Waiver Request Form (PDF)

Mentor Application Form (PDF)

Mentee Application Form (PDF)

Flexible Work and Telework Arrangement Request Form (PDF)

Telecommuting Agreement (PDF)

Foreign National Data Sheet (PDF)

I-9 Employment Eligibility Verification Form (PDF)

I-9 Instructions (PDF)

Statement of Computer Usage (PDF)

Personal Data Sheet (PDF)

Direct Deposit Authorization Form (PDF)

Tax Forms

W-4 Employee's Withholding Allowance Certificate (PDF)

IT-2104 Employee's Withholding Allowance Certificate New York State, NYC and Yonkers (PDF)

IT-2104.1 Employee's Withholding Allowance Certificate of Non-Residence (PDF)

Taxable Wage Worksheet (PDF)

Explanation of Amounts Reported on the Form W-2 (PDF)

Payroll Forms and Documents

Direct Deposit Authorization (PDF)

Stop Payment Authorization (PDF)

Payroll Expense Reclassification Request (PDF)

Viewing Payroll Online (PDF)

Bi-Weekly Payroll Schedule (PDF)

Monthly Payroll Schedule (PDF)

NYS Unemployment Record of Employment Form (PDF)

Benefits Upon Termination Full-time Faculty and Staff (PDF)

Benefits Upon Termination for Part-time Faculty (PDF)

Benefits Upon Termination 32BJ Facilities (PDF)

Benefits Upon Termination 32BJ Security (PDF)

Benefits Upon Termination Local 1205 (PDF)

Benefits Upon Termination Local 94 (PDF)

Benefits Upon Termination Temporary Employees (PDF)

COBRA Rates for Full-time Faculty and Staff (PDF)

COBRA Rates for Part-time Faculty (PDF)

Administrator/Instructional Services Approval Form