HR Forms

Forms are arranged by the following categories:

Benefits Forms
Employee Relations Forms
Employment Forms
Leaving Lehigh Forms
Recognition and Reward Forms
Staff Compensation Forms
Tuition Cash Grant Forms
Wellness Forms
Workplace Learning and Performance Forms
Workplace Posters

Benefit Forms
AFLAC Forms	Accident Claim Authorization to Obtain Information Critical Illness Claim Critical Illness Health Screening Direct Deposit (Electronic Funds Transfer)
Benefit Changes (Qualifying Life Events)	Making Changes to Benefits due to a Qualifying Life Event: Log into Connect Lehigh at https://connect.lehigh.edu/app/login Select Employee from the dropdown list Select Lehigh Benefits Click “View/Edit Your Benefits” on the right side of the screen Enter your changes
Capital Blue Cross Forms	Medical Expense Claim Form Spousal Surcharge Waiver Request (manually fillable pdf version) Spousal Surcharge Waiver Request (electronically fillable Word version)
Dental Plan Claim Form	United Concordia Claim Form
Domestic Partnership Forms	Affadavit of Common Law Marriage - Employee Affadavit of Common Law Marriage - Spouse Affadavit of Domestic Partnership Affadavit of Tax Qualified Dependent Statement of Termination of Partnership Tax Information on Health Benefits for Domestic Partners
Family Medical Leave	Accommodation Form for Faculty (Provost's Office) Lehigh Faculty FML Request Form for Birth of a Child or Placement of a Child Lehigh Faculty and Staff FML Request Form FMLA Certification of Health Care Provider
Flexible Spending Accounts (FSA)	WageWorks FSA Claim Forms WageWorks Healthcare FSA Eligible Expenses WageWorks Childcare Eligible Expenses
Leave Requests for Staff	Leave of Absence Form
LVAIC Cross Registration Form for Employees and Spouses	LVAIC Cross Registration Form
Mortgage Incentive Program	Home Buying Program Brochure Mortgage Payment Form Promissory Note
Personal Information Changes (changes in name, address, phone number, emergency contact, or marital status)	Personal Information Change Form (Word) Personal Information Change Form (pdf)
Prescription Plan Forms	Express Scripts Mail Order Form Express Scripts Request a New Prescription Form Express Scripts Coordination of Benefits/Direct Claim Form
Short Term Disability Plan Forms	Short Term Disability Claims Procedure Authorization for Release of Information Attending Physician's Statement Physician's Release to Return to Work
Tuition Cash Grant	2018-19 Tuition Cash Grant Application (pdf) 2018-19 Tuition Cash Grant Fact Sheet (pdf) 2017-18 Statement of Dependency Form (pdf)
Vision Plan Forms	Davis Vision Claim Form

Employee Relations Forms
Accommodation Request	Request for Reasonable Accommodation Medical Information Request and Verification Form
Flextime Guidelines	Flextime Guidelines document

Employment Forms
Employment Applications (apply for positions through our online system)	Online Application System
Employment Request Forms	Faculty Employment Request Form Please contact HR (Monica Guiher or Aubrie Fenicle) for on-line Staff Employment Request Form (SERF)
Employment Eligibility Verification (I-9)	I-9 Form

Employment Forms

Employment Applications

(apply for positions through our online system)

Online Application System

Employment Request Forms

Faculty Employment Request Form
Please contact HR (Monica Guiher or Aubrie Fenicle) for on-line Staff Employment Request Form (SERF)

Employment Eligibility Verification (I-9)

I-9 Form

Leaving Lehigh Forms
Staff Separation Forms	Request for Reference And Release Employee's Separation Information Sheet Supervisor's Separation Plan Checklist
Exit Interview Questionnaires	Employees Transferring Within Lehigh Employees Leaving Lehigh

Recognition and Reward Forms
Spot Bonus Award	Nomination Form (word)
Tradition of Excellence Award	Tradition of Excellence Nomination Form (pdf)

Staff Compensation Forms
Extra Duty Compensation	Extra Duty Form (pdf) Extra Duty Form (word)
On-Campus Consulting	On-Campus Consulting Form (pdf) On-Campus Consulting Form (word)
Position Descriptions	How to access your position description
Position Re-evaluation Requests	New Position Approval/Staff Request Form (pdf) Position Re-evaluation/Staff Request Form (pdf) Position Re-evaluation Request Form (pdf)
Request for Deferred Pay Exception	Staff Request to Abstain from Deferred Pay Program
Temporary Bonus Request	Temporary Bonus Request Form (word) Temporary Bonus Request Form (pdf)
Timesheets	Predated Timesheets (nonexempt/exempt staff) Special Rates Timesheets

Wellness Forms
Flu Shots	Flu Shot Voucher
Health Scan PLUS	HealthScan PLUS Registration Form

Workplace Learning and Performance Forms
BEST Program	BEST Program Registration Form (word) BEST Program Registration Form (pdf)
Performance Management	GPS Performance Management Resources Performance Improvement Plan Form Self-Appraisal Preparation Form Success Factor Worksheet - Core Success Factor Worksheet - Managerial
Training Programs	Make the Most of Training - Employees Make the Most of Training - Supervisors Training Registration Tool Workplace Learning Calendar

Workplace Learning and Performance Forms

BEST Program

Performance Management

GPS Performance Management Resources
Performance Improvement Plan Form
Self-Appraisal Preparation Form
Success Factor Worksheet - Core
Success Factor Worksheet - Managerial

Training Programs

Workplace Posters - Federal and State Labor Laws
Federal Workplace Labor Law Posters	Equal Employment Opportunity Fair Labor Standards Act Family Medical Leave Act Government Contracts OSHA Job Safety and Health Polygraph Protection Uniformed Services Employment Rights
State Posters for Pennsylvania	Child Labor Laws (Employment of Minors) Equal Pay Law Human Relations Act Minimum Wage Law Unemployment Compensation Notice

Human Resources

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