Statewide Office of Human Resources

Personnel Forms (Internal)


Change Form

To request a change to name, address, phone number, marital status, and/or Social Security number for an employee, student, and/or vendor.

Employees and students can change their address online through UA Online.  

PDF

 
Demographic - Personal Data

To document employee demographic information.

PDF

 
Estate Disbursal

To request Disbursal of pay to employee estate (HR office use only).

PDF

 
Estate Form - Affidavit for Collection of Personal Property of Decedent

For a successor to claim/collect property from a decedent's estate in the event that no will is present (State of Alaska Court System Form P-110).

Enterable PDF (AK Court System site)

 

FML: Q & A's

Questions and answers regarding Family Medical Leave (FML).

PDF

 
FML Request Form

To request FML leave for a serious health condition (to be completed by employee).

PDF

 
FML: Certification of Health Care Provider for Employee's Serious Health Condition

To support an employee's FMLA leave request due to the employee's own serious health condition (to be completed by the employee, employer, and the employee's health care provider).

Enterable PDF (Dept of Labor site)

 
FML: Certification of Health Care Provider for Family Member's Serious Health Condition

To support an employee's FMLA leave request due to a family member's serious health condition (to be completed by the employee, employer, and the family member's health care provider).

Enterable PDF (Dept of Labor site)

 
FML: Certification of Qualifying Exigency for Military Family Leave

To support an employee's FMLA leave request due to a qualifying military exigency (to be completed by the employee and employer).

Enterable PDF (Dept of Labor site)

 
FML: Certification for Serious Injury or Illness of Covered Servicemembers - for Military Family Leave

To support an employee's FMLA leave request due to the serious health condition of a covered servicemember (to be completed by the employee or covered servicemember, employer, and DOD health care provider).

Enterable PDF (Dept of Labor site)

 
FML: Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

To support an employee's military caregiver FMLA leave request due to the serious health condition of a covered veteran (to be completed by the employee or covered servicemember, employer, and DOD health care provider).

Enterable PDF (Dept of Labor site)

Health Insurance Market Place Coverage Notice

Marketplace Exchange Notice

I-9 Form

To verify employment eligibility within the U.S.

Enterable PDF (USCIS site) **This form requires Adobe Acrobat**

Non-Enterable PDF (USCIS site)

 
Job Form

To record additions, deletions, or changes to job assignments.

NEW!  Electronic Submission of Job Forms is now available for UAF and UAA satellite departments.  Submit job forms and supporting documentation through NextGen rather than delivering hard copy forms.   This feature will be coming to the rest of UA September 16, 2019.

Job Form Submissions – New Hire & Re-Hires – Currently Inactive Employees

Job Form Submission - Existing Employee Changes – Currently Active Employees

PDF, Enterable PDF

 
Performance Appraisal Form

Template for an employee and their immediate supervisor to appraise the employee's work performance, set future goals and career development, and provide feedback. Definitions are included at the end of the form for reference.

Enterable PDF

Note: To save a copy of the PDF file with your entries, use Acrobat Reader 8.0 or higher to complete the form.

 
Relocation Allowance Request Form

To request a relocation allowance.

PDF

 
Social Security Card Application (SS-5 Form)

Instructions and form to apply for a social security card.

External Site (SSA site)

 
Social Security Exemption Letter & Form for Temporary Employees / Rehired Retirees

Letter and form for rehired retirees in a temporary staff or adjunct faculty position to designate their eligibility for retirement benefits and exemption from Social Security withholding.**

Enterable PDF

**Employees who are exempt from withholding must also complete Form SSA-1945: "Statement Concerning Your Employment in a Job Not Covered by Social Security" Enterable PDF (SSA Site)

 
Student Employee Waiver Form

For student employees to request a waiver of UA Student Employment policies (e.g. minimum GPA, weekly work hours limit).

PDF

 
Student Status Verification

Required for student employment only.

PDF, Enterable PDF

 
System Termination

To document termination of employment.

Enterable PDF

 
System Termination - Employee Exit Letter

Exit letter template for the department to complete/provide to an employee upon their termination, if the employee is not notified of the termination by email via the Termination Workflow process.

PDF, Enterable PDF

 
System Termination - Supervisor Notification of Employee Termination

Letter template for the department to provide to the supervisor of a terminating employee, if the supervisor is not notified of the termination by email via the Termination Workflow process.

PDF

Telecommuting Agreement (Within Alaska)

Agreement for employees who will be working remotely within the State of Alaska.

Electronic Form

 
UA Computer Administrative Access Request Form

Campus form or site for employee to request access to specific security classes for Oracle, Banner applications, databases, Vista Plus, etc.

UAA | UAF | UAS | SW

 
UA Computer Account Request Form

Campus form or site for employee to request access to UA domains, email, Blackboard, VPN, etc.

UAA | UAF | UAS | SW

 
UA Choice ACA Health Plan Enrollment

Enrollment information and forms for temporary employees who qualify to enroll for coverage under the University's health plan.

Benefits site

 
UA Health Plan Coverage Offer Form for Extended Temporary Employees Eligible Upon Hire

Directions for hiring department or campus HR office:
Complete the date fields at the top of the form when providing the form to the qualifying employee.

Health care offer form for extended temporary employees who are eligible to enroll upon hire. Refer to the ACA guidance document for details on assignments that may or may not qualify.

Refer to the Benefits site for enrollment information and forms for employees who qualify per ACA regulations.

PDF

 
UA Health Plan Coverage Offer Form for Temporary Employees Eligible Upon Hire

Directions for hiring department or campus HR office:
Complete the date fields at the top of the form when providing the form to the qualifying employee.

Health care offer form for temporary employees who are eligible to enroll upon hire. Refer to the ACA guidance document for details on employee assignments that may qualify (e.g. firefighters and resident assistants).

Refer to the Benefits site for enrollment information and forms for employees who qualify per ACA regulations.

PDF

 
UA Choice Health Plan Enrollment Form - R/V Sikuliaq Employees - FY17

R/V Sikuliaq Employee Use Only
To enroll in one of the three UA health plans (750, HDHP, or CDHP) for the plan period of July 1, 2016, through June 30, 2017.

PDF, Enterable PDF

 

To report any issues with this web page, contact ua-syhr@alaska.edu.

 
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