UMBC Dept. of Human Resources

Forms

General
Benefits
Compensation/Classification
Employee Relations
Employment
Human Resource Information Systems
Payroll
PMP

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GENERAL

		Employee Assistance Program (EAP) Supervisory Referral Form
		UMBC Quarterly Staff Recognition Award Nomination Form
		UMBC Telework Policy and Agreement

BENEFITS

General

Change of Name/Address Form

Tuition Remission

Tuition Remission

Health Benefits

FY 2009 Regular Employee Enrollment Worksheet

FY 2009 COBRA/LAWP/Contractual Worksheet

HIPAA Authorization Form

Affidavit/Dependent/Certification Forms

Required Documentation for Dependents

Certification of Dependent Eligibility

Disabled Dependent Certification Form

Affidavit for All Dependent Children Added Effective 7/1/08 or Later

Life Insurance

Beneficiary Form for UNUM Term Life Insurance

MetLife Term Life Insurance Beneficiary Form

MetLife Statement of Health

UNUM Term Life Enrollment Form

Disability

UNUM Long Term Disability Enrollment Form

Accidental Death & Dismemberment

Met Life Accidental Death & Dismemberment Beneficiary Form

Flexible Spending Account

Flexible Spending Account Direct Deposit Form

Health Care Spending Account Claim Form

Dependent Care Spending Account Claim Form

Leave

Advanced Sick Leave Form Revised 4/08

Leave Donation Form

Leave Reserve Fund Request Form

Request for Extended Sick Leave Form

Request for Family/Medical Leave (FMLA) Form Revised 4/08

Advanced Vacation Leave

Retirement Forms
		Retirement Plan Selection Form
Supplemental Retirement Account Change Forms
		TIAA-CREF 403 (b)
		Fidelity 403 (b)
		TIAA-CREF 457 (b)
		Fidelity 457 (b)

COMPENSATION/CLASSIFICATION

		Classification Action Request Form Revised 6/08
		Position Description
		UMBC Position Request Form Revised 6/08
		Summer Pay Position Request Form Revised 4/08
		Request for Approval of Acting Capacity Status Form

EMPLOYEE RELATIONS

		Disciplinary Action Form
		NOTE: Please contact the Department of Human Resources for technical assistance prior to taking any disciplinary action.

EMPLOYMENT

		Application
		Contingent I Requisition Revised 11/06
		Contingent I Agreement Revised 11/06
		Addendum to Personal Services Contract
		UMBC Preliminary Recruitment & Selection Report Revised
		UMBC Hiring Exception Revised 3/07

HUMAN RESOURCES INFORMATION SYSTEMS

Report/Label Request

PAYROLL