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Human Resources Forms

How do I...

1. Change my address and/or personal information?

Personal Information Self-Service Online Link* 

*Use this link to update your address, legal name and view your paycheck.  If any other information needs updating such as name, degree, emergency contacts, etc., please print the Personal Information form and send to Human Resources & Payroll Services, Doty Hall 318. For further instructions, view this helpful powerpoint: Instructions for Accessing Self-Service Link

Additionally, when you change your address -- remember you will need to contact any union sponsored benefits that you may have (dental, vision, life insurance, etc.) and your retirement carriers including any tax-deferred annuity providers you may have.  PRINT THIS ADDRESS CHANGE LIST DOCUMENT FOR CONTACT INFORMATION.

2.  Add a newborn to my health insurance coverage?

To add a newborn baby to your health insurance, you'll need to complete the NYS Health Insurance Transaction Form (PS 404) which is found in the benefits section of this HR Forms page. Complete Nos. 1-9, add the newborn baby's name and date of birth in No. 13, then sign and date. Once you receive the baby's birth certificate and social security card, you will need to send copies of each to Victoria Phipps (phipps@geneseo.edu).

3. Contact your Health Benefits Administrator (Victoria Phipps)?

Contact your HBA within 7 days of life-changing events to best avoid delays in coverage and retro charges in your paycheck! Examples of life-changing events are:

  • change in marital status;
  • the birth of a baby;
  • change of address;
  • going on a leave without pay;
  • retirement;
  • check out the full list HERE

You will need to complete the NYS Health Insurance Transaction PS 404 Form. Additional documentation may be required. Contact Victoria at phipps@geneseo.edu or 585-245-5616.

 

New Employee Required Forms Packet

 

Classification Forms

FLSA Questionnaire Professional Staff

Job Description Questionnaire

Independent Contractor - Checklist for Determining Workers Status

Independent Contractor - Guide to Determining Workers Status

Request for Reclassification of Classified Position

Recruitment & Selection Forms

Applicant Release for Background Investigation

Facilities Services Application for Employment

Internal Career Advancement Request Form

Invitation for Self-Identify for Veterans

Offer Summary for New Faculty Appointment

Offer Summary for New Professional Appointment

Offer Summary for New M/C Appointment

Staffing Plan Support Documentation Form

Vacancy Announcement (Classified Service)

Vacancy Announcement Facilities Services (Classified Service)

Voluntary Self-Identification of Disability

Waiver of Recruitment

Appointment Forms

Confidentiality Statement

Employee Information Form for New Employees

Extra Service Form/Extra Service Matrix

Form I-9, Employment Eligibility Verification

Geneseo Employment Recommendation Form (GER)

Internal Career Advancement Form

Oath of Office Statement

Professional Staff Request for Review of Salary Increase or Promotion

Request for Approval of Extra Service - MC Employee (UP6)

Request for Approval of Extra Service - UUP Employee (UP8)

Request for Approval of Professional Appointment - Continuing, Permanent,

Separation Sign-off Form Staffing Plan Form

Tenure Clock Stoppage Form

Title F Leave Application Volunteer Application

UP3

Benefits Forms

CSEA Dental and Vision Online Enrollment

CSEA Membership Application Form

CSEA Student Verification Form

Domestic Partner Enrollment Application & Instructions, PS-425

Domestic Partner Dependent Tax Affidavit for Enrollment in NYSHIP, PS-425.3

Domestic Partner Termination Form, PS-425.4

Employees Retirement System Membership Registration Form, RS5420

Intent to Resign/Retire Letter Template

M/C Davis Vision Student Verification Form

M/C GHI Dental Student Verification Form

NYS Health Insurance Transaction Form (PS-404)

Required Proofs for NYSHIP Document

NYSHIP Sick Leave Credit Option Election Form (PS-405)

NYSHIP Opt Out Attestation Form (PS-409)

Police and Fire Membership Application, PF 5022

Request for Coverage Under the Young Adult Option (YAD-NYPE)

Retirement Election - Retirement@Work

Retirement Election Form for Optional Employees

NYS Employees' Retirement System Application for Membership

Teachers' Retirement System Application for Membership

UUP Dental/Vision Enrollment Form 

UUP Membership Application  -- UUP has created an  e-membership card that prospective members can fill out online and send electronically to UUP—instantly making them a UUP member. This application will not enroll you in the Dental/Vision Benefits. See above for UUP Dental and Vision Enrollment Form.

UUP Change of Marital or Dependent Status Form

UUP Student Verification Form

Ethics Forms

Honoraria

Official Activity Expense Payment

Outside Activity for Policy Makers Only Only (if over $5,000)

Leaves Forms

Covid-19 Leave Request Form

Employee On-The-Job Accident and Injury Report

Estimated Physical Capabilities

FMLA Essential Responsibilities

FMLA Leave Request FMLA Leave Request - Adoption Placement

NYS Paid Family Leave Forms NYS Paid Family Leave

NYS Paid Family Leave Statement of Rights

Return to Work Form

WH-380E: Certification of Health Care Provider for Employee's Serious Health Condition

WH-380F: Certification of Health Care Provider for Family Member's Serious Health Condition

WH-384: Certification of Qualifying Exigency for Military Family Leave

WH-385: Certification of Serious Injury or Illness of Covered Service Member- for Military Family Leave 

UUP & MC Active Military Leave Forms

UUP & MC Bonding Leave Packet

UUP & MC Family Care Leave Forms

Payroll Forms

Direct Deposit

Guide to Completing Direct Deposit Form

Direct Deposit Reactivation Request

Federal Tax W-4 (IRS Tax Withholding Estimator)

NYS Tax Withholding IT-2104

Overtime Authorization

Manage SUNY Tax-Deferred Annuity - SUNY Retirement@Work
(Replaces Salary Reduction Agreement Form)

W-2 Reprint Request

Performance Management Forms

Annual Performance Evaluation - CSEA

M/C Performance Program M/C Performance Evaluation

M/C Performance Appraisal (NU-06)

Monthly Evaluation - Classified Staff Professional Evaluation

Professional Performance Program

Professional Performance Evaluation

Professional Review Request

Professional Self-Assessment

Professional Secondary Source

Performance Evaluation Program Form - PEF 

Performance Evaluation Form for UP 01 Performance Evaluation Form for UP 02

Time & Attendance Forms

Cancer Screening Leave

Classified Staff Holiday Certification (GP-8)

Classified Time and Accrual Worksheet

Graduate Assistant/Teaching Assistant Attendance Report Form

Holiday Waiver (Classified Service Only)

Hourly Employee Biweekly Time Sheet

Productivity Enhancement Program - Classified Service Employees

Productivity Enhancement Program - MC Professional Employees

Productivity Enhancement Program - UUP Professional Employees

Voluntary Reduction in Work Schedule Application (VRWS)

Voluntary Reduction in Work Schedule Guidelines

Training & Development Forms

Tuition Waiver B-140W

UUP Tuition Waiver Application 

Student Forms

Federal Work Study Time Record

Federal Work Study Award Tracker for Students & Supervisors

Graduate Student Employee Attendance

Information for Students

Student Employee Orientation Checklist

Student Employment Supervisor Handbook

Student Employee Retirement Option

Student Employment Forms Guideline

Student Online Timesheet Instructions

Temp Service Appointment Form

Temp Service Time Record 

Miscellaneous Forms

Geneseo Pride Nomination

Human Resources Data Request

Human Resources Label Request

Reasonable Accommodation Request

Alternative Work Location Agreement

Request to View Personnel File

Visitor COVID Screening Questionnaire