Forms

Forms are grouped by category:

• HR/PAYROLL FORMS
• EMPLOYMENT
• BENEFITS
• COMPENSATION
• ORGANIZATIONAL
• INFORMATION CHANGES
• AWARDS
• OTHER

HR/PAYROLL FORMS

• Staff Personnel Action Form Form — Instructions
• Exempt Staff Vacation Report Form — Instructions
• Non-Exempt Weekly Report of Absences and Overtime Worked
• Staff Position Management Form
• Separation Form
  • Instructions
• On-Call and Temporary ID Card requests

EMPLOYMENT

Welcome Letter – New Hire Paperwork Instructions – click here

New Employee Package

• Federal Tax Withholding Form W-4
• Indiana Tax Withholding Form W-4 (Click on WH-4 to access PDF)
• Michigan Tax Withholding Form W-4
• Illinois Tax Withholding Form W-4
• Employment Eligibility (I-9) Form
• J-1 Visa Form

Direct Deposit

• Authorization Agreement for Automatic Deposits

Recruitment

• Criminal Background Report Authorization – Employee
• Criminal Background Report Authorization – Volunteer
• Employment Reference Check
• Intent to Employ
• Pre-Employment Form

Exit Interview

• Exit Interview Form

BENEFITS

Absences and Leaves

• Exempt Staff Vacation Report Form — Instructions
• Non-Exempt Weekly Report of Absences and Overtime Worked
• CareWorks USA Return-To-Work/Work Release form
• Military Leave Supervisor Checklist
• Absentee and Vacation Reporting Access Form – 68 KB PDF
• Leave of Absence Form Instructions

Education Benefits

• Degree Seeking Application for Employee and Employee Spouse Educational Benefit
• Application for Educational Benefits
• Fred E. Freeman Staff Scholarship Fund Application
• Non-Degree Seeking Application for Employee and Spouse Educational Benefit
• Non-Notre Dame Tuition Reimbursement

Flexible Spending Accounts

• Dependent Care Worksheet
• Health Care Worksheet
• Meritain Health Care Request for Reimbursement Form
• Meritain Health Dependent Care Claim Form
• Spending Account Direct Deposit Form

Group Life Benefits

• Evidence of Insurability – Minnesota Life – 198KB PDF
• Group Life & Travel Beneficiary Form Designation
• LTD Physician Claim Form
• LTD Employee Claim Form

Medical, Dental and Vision Benefits

• 2012 FLEX Benefits Enrollment Application
• EyeMed Out of Network Claim Form
• Meritain Health Claim Form – 127 KB PDF
• Delta Dental Claim Form

Prescription Drug Benefit

• Medco Health Home Delivery Pharmacy Service Order Form
• Medco Health Prescription Drug Reimbursement Form

Retirement

• Voluntary Employee Contributions Form
• Mandatory Employee Contributions Form
• Fidelity Investments 403b Application
• Fidelity Transfer Rollover Form
• Fidelity Change of Address Form
• Fidelity Change of Beneficiary Form
• Vanguard 403(b) Retirement Plans Enrollment and Change Form
• Vanguard 403b Transfer Form
• Vanguard Rollover Form
• TIAA-CREF 403(b) Enrollment Form
• TIAA CREF Transfer Rollover Form
• Withholding Certificate for Pension or Annuity Payments Form W-4P

Claim Forms

• Prescription Mail Order Form
• Anthem Prescription Drug Claim Form
• Anthem Major Medical Claim Form
• Anthem Major Medical Claim Form
• Anthem International Medical Claim Form

Other

• Non-Employee NetID Request Form
• Adoption Form

COMPENSATION

Overtime

• Report of Absences and Overtime Worked Form
• Absentee and Vacation Reporting Access Form – 68 KB PDF

Staff Position Management Form

• Staff Position Management Form

Additional Pay for Services

• Form
• Instructions

ORGANIZATIONAL

Performance

• 90 Day Orientation Review Form (Word 97)
• Nonexempt Complaint Procedure Form
• Nonexempt Performance Review (PDF)
• Exempt Performance Management Review Form and Instructions

Work Life

LifeWorks/Employee Assistance Program

• Release of Information – Management Consultation/Work Issues
• Release of Information – Substance Abuse

INFORMATION CHANGES

Withholding

• Federal Tax Withholding Form W-4
• Indiana Taxwithholding Form W-4 (Click on WH-4 to access PDF)
• Michigan Form W-4
• Illinois Taxwithholding Form W-4

Personal

• Name and Address Change Form

AWARDS

• Team Irish Award Nomination – Closed
• Presidential Award & Notre Dame Award of Merit Nomination – Closed

OTHER

• Employee Compassion Fund Information and Form
• Confidential Information Statement – People EZ

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