HR 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)

• United Concordia Claim Form

• 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

• 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

• WageWorks FSA Claim Forms
• WageWorks Healthcare FSA Eligible Expenses
• WageWorks Childcare Eligible Expenses

• Leave of Absence Form

• LVAIC Cross Registration Form

• 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

• 2018-19 Tuition Cash Grant Application (pdf)
• 2018-19 Tuition Cash Grant Fact Sheet (pdf)
• 2017-18 Statement of Dependency Form (pdf)

• Davis Vision Claim Form

• Request for Reasonable Accommodation
• Medical Information Request and Verification Form

• Flextime Guidelines document

Employment Applications

(apply for positions through our online system)

• Online Application System

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

• I-9 Form

• Request for Reference And Release
• Employee's Separation Information Sheet
• Supervisor's Separation Plan Checklist

• Employees Transferring Within Lehigh
• Employees Leaving Lehigh

• Nomination Form (word)

• Tradition of Excellence Nomination Form (pdf)

• Extra Duty Form (pdf)
• Extra Duty Form (word)

• On-Campus Consulting Form (pdf)
• On-Campus Consulting Form (word)

• How to access your position description

• New Position Approval/Staff Request Form (pdf)
• Position Re-evaluation/Staff Request Form (pdf)
• Position Re-evaluation Request Form (pdf)

• Staff Request to Abstain from Deferred Pay Program

• Temporary Bonus Request Form (word)
• Temporary Bonus Request Form (pdf)

• Predated Timesheets (nonexempt/exempt staff)
• Special Rates Timesheets

Flu Shots

• Flu Shot Voucher

• HealthScan PLUS Registration Form

• BEST Program Registration Form (word)
• BEST Program Registration Form (pdf)

• Read about the new Online Draft Book here

• Make the Most of Training - Employees
• Make the Most of Training - Supervisors
• Training Registration Tool
• Career Enrichment Calendar

• Equal Employment Opportunity
• Fair Labor Standards Act
• Family Medical Leave Act
• Government Contracts
• OSHA Job Safety and Health
• Polygraph Protection
• Uniformed Services Employment Rights

• Child Labor Laws (Employment of Minors)
• Equal Pay Law
• Human Relations Act
• Minimum Wage Law
• Unemployment Compensation Notice