Policies / Forms - Human Resources at Ohio State

• Adoption Assistance Reimbursement Request Form

• Internal Supplemental Compensation Approval
• Salary Adjustment and Reclassification

Short and Long-Term Disability

• Accommodation Request Medical Certification
• Application for Leave
• Benefit Continuation During Unpaid Leave Election
• eLeave
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Long-Term Disability (LTD) Conversion Form
• Long-Term Disability (LTD) Evidence of Insurability (EOI)
• Return to Work Release
• Short-Term Disability (STD) Claim, Authorization – Unum
• Short-Term Disability (STD) Election Form
• Short-Term Disability (STD) Evidence of Insurability (EOI)
• Short-Term Disability (STD) Claim, Authorization – University

CCS Disability Separation

• CCS Disability Separation Request
• Integrated Disability Pre-Reinstatement Hearing Waiver
• Request for Placement on Voluntary Disability Separation

Workers’ Compensation

• Accommodation Request Medical Certification
• Application for Leave
• Benefit Continuation During Unpaid Leave Election
• eLeave
• Employee Accident Report
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Return to Work Release
• Safe Mobility and Repositioning Techniques - Patient Handling Accident Investigation Checklist

Return to Work (RTW)/Remain at Work Accommodations

• Accommodation Request Medical Certification
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Return to Work Release

Corrective Action/Performance Improvement

• Coaching Worksheet
• Formal Counseling Letter - Unclassified Staff (Example)
• Hearing Request - Classified Civil Service Staff
• Hearing Request/Corrective Action Form - CWA Staff
• Letter of Acceptance - Resignation in Lieu of Termination (Example)
• Paid Administrative Leave Letter (Example)
• Performance Improvement Plan - Format 1 (Example)
• Performance Improvement Plan - Format 2 (Example)
• Termination Letter - Unclassified Staff (Example)
• Unpaid Administrative Leave Letter (Example)
• Written Coaching/Level Notice Form - Classified Civil Service Staff

Disputes

Mediation

• Agreement to Mediate
• Settlement Agreement

Nepotism

• Alternative Arrangement Agreement to Comply with Nepotism Policy 1.25

Sexual Harassment and Discrimination

• Workplace Complaint Form

Veterans Affairs

• Veterans Post-Offer Self-Identification

Whistleblower

• Whistleblower Report Form

Workplace Violence

• Incident Report for Workplace Violence

Background Check

• Background Check Application
• Background Check Disclosure and Authorization Form
• Fingerprint Consent
• Fingerprint Request

General

• Flexible Work Arrangement Proposal
• Request for Fitness for Duty
• Request for Prior Service Certification from The Ohio State University
• Request for Reduction in Work Force
• SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (now on DocuSign - see Instructions)
• Staff External Work Approval Request

Hiring

• Employment Eligibility Verification (I-9) Form
• Employment Eligibility Verification (I-9) Form - Paper Version
• Employment Eligibility Verification (I-9) Form Instructions
• Equal Employment Identification
• Fraud Reporting System Information Acknowledgement (now on DocuSign - see Instructions)
• Hire Data Worksheet (now on DocuSign - see Instructions)
• Ohio Ethics Law Acknowledgement (now on DocuSign - see Instructions)
• Request to Rehire Retired Faculty/Staff Member
• SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (now on DocuSign - see Instructions)
• Voluntary Self-Identification of Disability (now on DocuSign - see Instructions)

• FSA Election Form
• Health Care FSA, HRA and/or Dependent Care FSA Reimbursement Claim Form

• Staff Career Development Grant Application
• Staff Manager Development Grant Application

Benefit Continuation

• Application for Continued Health Plan Eligibility for Over Age Dependents
• Benefit Continuation During Unpaid Leave Election

Medical

• CoreSource Electronic EOB Registration Form
• CoreSource Health Insurance Claim Form
• CoreSource Health Insurance Claim Form - Lactation Services and Hospital Grade Breast Pumps
• CoreSource Hospital Based/Physician Directed Weight Loss Claim Form
• CoreSource Request for Additional Coverage Information
• Health Election Form
• Health Election Form (ACA)
• HIPAA Privacy Practices
• Out-of-Area Benefit Election Form
• Prescription Drug Home Delivery Form
• Prescription Drug Reimbursement Form
• Health Election Form (Graduate Associates)

Vacation, Sick and Other Leave

• Application for Leave
• Benefit Continuation During Unpaid Leave Election
• eLeave
• Vacation Donation - Donor Agreement
• Vacation Donation - Recipient Agreement

Family and Medical Leave

• Application for Leave
• Benefit Continuation During Unpaid Leave Election
• eLeave
• FML Certification for Serious Injury or Illness of Covered Servicemember
• FML Certification of Qualifying Exigency for Military Family Leave
• FML Designation Notice
• FML Medical Certification of Health Care Provider for Employee’s Serious Health Condition
• FML Medical Certification of Health Care Provider for Family Member’s Serious Health Condition
• FML Notice of Eligibility and Rights and Responsibilities
• Leave as an Accommodation Medical Certification
• Return to Work Release

• Dependent Group Term Life Insurance (DGTLI) Enrollment Form
• Group Term Life Insurance (GTLI) Waiver of Entitlement
• Life Insurance Beneficiary Designation
• Post-Retirement Life Insurance Beneficiary Designation
• Retiree Group Term Life Insurance (GTLI) Beneficiary Designation
• Retiree Group Term Life Insurance (GTLI) Waiver of Entitlement Form
• Voluntary Group Term Life Insurance (VGTLI) Enrollment Form

General

• ARP Provider Change Form
• Request for Prior Service Credit Certification
• Retirement Distribution Certificate Request
• Retirement Program Election Form
• SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (now on DocuSign - see Instructions)

Ohio Public Employees Retirement System (OPERS)

• Notice of Re-Employment of a OPERS Retiree
• OPERS Authorization for Release of Account Information
• OPERS Independent Contractor Acknowledgement
• OPERS Request for Optional Exemption as a Student

State Teachers Retirement System (STRS)

• STRS Authorization for Release of Account Information
• STRS Exemption from Contributions for Student Employees Form
• STRS GTA Retirement Election Form
• STRS Reemployed Retiree Notification
• STRS Verification of Employment and Employer Health Care Access

Supplemental Retirement Account (SRA)

• 403(b) Supplemental Retirement Account Salary Reduction Agreement (or enroll online)
• 457(b) Supplemental Retirement Account Salary Reduction Agreement (or enroll online)

Returning Retirees

• Notice of Re-Employment of a OPERS Retiree
• Request to Rehire Retired Faculty/Staff Member
• STRS Reemployed Retiree Notification
• STRS Verification of Employment and Employer Health Care Access

Student Retirement

• OPERS Request for Optional Exemption as a Student
• STRS Exemption from Contributions for Student Employees Form
• STRS GTA Retirement Election Form

• Certificate of Domestic Partnership for Sick, and Family and Medical Leave

• Graduate Associates, Fellows and Trainees University Health Insurance Subsidy Waiver
• Payroll Deduction of Other Fees for Graduate Associates

• Dependent Tuition Assistance Application
• Faculty and Staff Tuition Assistance Request for Course Enrollment During Regularly Scheduled Work Hours
• Faculty and Staff One-Time-Forgiveness Benefit Application