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
Career Enrichment 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) only for qualifying life events; Open Enrollment requests should be submitted via the online waiver request survey in the Lehigh Benefits website. Spousal Surcharge Waiver Request (electronically fillable Word version) only for qualifying life events; Open Enrollment requests should be submitted via the online waiver request survey in the Lehigh Benefits website.
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 Certification of Healthcare Provider Form (for the employee) Certification of Healthcare Provider Form (for a family member)
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 (Docusign)
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	Tuition Cash Grant Application (pdf) Tuition Cash Grant Fact Sheet (pdf) 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 Special Parking/Transportation Form
Flextime Guidelines	Flextime Guidelines document

Employment Forms
Employment Applications (apply for positions through our online system)	Online Application System
Employment Eligibility Verification (I-9)	I-9 Form

Employment Forms

Employment Applications

(apply for positions through our online system)

Online Application System

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 Personnel Information Change Form (Docusign)
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 Compensation Request Form (login required)
On-Campus Consulting/Additional Compensation for Exempt Employees	On-Campus Consulting/Additional Compensation for Exempt Employees Request Form (login required)
Position Descriptions	How to access your position description
Request for Deferred Pay Exception	Staff Request to Abstain from Deferred Pay Program
Temporary Bonus Request	Temporary Bonus Request Form (login required)

Wellness Forms
Health Screening for Be Well program	LabCorp Health Screening Form - Be sure to complete the form before entering the lab, including marking any requests for supplemental tests.

CAREER ENRICHMENT and Performance Forms
BEST Program	BEST Program Registration Form (word) BEST Program Registration Form (pdf)
Performance Management	Read about the Performance Management Process
Career Enrichment @ Lehigh (CE@L) Programs	Learn about Career Enrichment @ Lehigh Register for CE@L Programs View the CE@L Calendar Download the Career Enrichment Playbook

CAREER ENRICHMENT and Performance Forms

BEST Program

Performance Management

Read about the Performance Management Process

Career Enrichment @ Lehigh (CE@L) 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

Search form

You are here