Forms

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Click Form Title to View Adobe Reader Version

• All Forms, A-Z

  
  

  311-T Change Form	Word version
  403(b) TIAA-CREF
  403(b) Fidelity
  403(b) Voluntary Salary Deferral Agreement Form
  457(b) Fidelity
  457(b) TIAA-CREF
  457(b) Voluntary Salary Deferral Agreement Form
  Adjunct Faculty Contract	Word version
  Affidavit for Dependent Children
  Affidavit for Domestic Partnership
  Affidavit for Spousal Eligibility
  Applicant Flow Data for Scheduled Interviews	Word version
  Application for Service or Disability Retirement
  Application to be Placed on a Qualifying Approved Leave of Absence
  Candidate Travel Expense Reimbursement
  Central Payroll Address Change Form
  Commuter Choice Program
  Contingent I Contract	Word version
  Contingent II Contract	Word version
  Designation of Beneficiary
  Direct Deposit Authorization
  Direct Deposit Authorization for Retirees
  Disabled Dependent Certification Form
  Election Not to Participate
  Employee Request for Family and Medical Leave
  Employment Application	Word version
  Enrollment Form for Active & Satellite Employees (July 2011 - June 2012)
  Enrollment Form for Direct Pay Employees (July 2011 - June 2012)
  Enrollment Form for Retirees (July 2011 - June 2012)
  Estimate of Disability
  Estimate of Disability for Police Officers
  Estimate of Service Retirement
  Estimate of Service Retirement for Police Officers
  Federal and State Tax Withholding
  Federal Work-Student Agreement Form	Word version
  FMLA Certification by Physician Form
  Graduate Assistant Contract	Word version
  Health Benefits Personal Information Change Form
  HIPAA Authorization Form
  HR Demographic Form (Employee Information Form)	Word version
  Interview Evaluation	Word version
  Job Candidate Travel Expense Reimbursement
  Key Provisions of FMLA
  Maryland W-4 (Employee withholding allowance certificate)
  Maryland W-4 Instructions
  MetLife Life Insurance Beneficiary Form
  MetLife PA&D Beneficiary Form
  MetLife Statement of Health Form
  Multiple Memo Pay Contract Renewal	Word version
  Part-time Faculty Payroll Authorization
  Part-time Faculty Payroll Authorization Change Notice
  Performance Management Process, 2012-2013	Word version
  Personnel Requisition	Word version
  Personnel Requisition for Temporary Clerical Services
  Position Description	Word version
  Preliminary Application for Disability Retirement
  Reemployment After Retirement
  Reemployment After Retirement - Police Officers
  Request for Position Reclassification
  Request to Hire Contractual Employee*
  Request to Purchase Previous Service
  Retirement Credit Request for Active Military Service
  Return to Work Medical Certification Form
  SECU Direct Deposit Authorization
  Secondary Employment	Word version
  Selection Criteria	Word version
  Separation/Termination from Service
  Statement of Disability
  Student Assistant Employment Agreement*
  Substance Abuse Policy Acknowledgment Form
  Tuition Remission Form
  UNUM Lifestyle and Long Term Disability Enrollment
  UNUM Lifestyle Plan Beneficiary Form
  UNUM Long Term Disability Claim Form
  W-4 for Maryland Employees Residing in D.C.
  W-4 Supplemental Form for Non-Residents

• Benefits

  Health (Visit Dept. of Budget & Management's Health Benefits forms page for additional forms and instructions.)
  Affidavit for Dependent Children
  Affidavit for Domestic Partnership
  Affidavit for Spousal Eligibility
  Disabled Dependent Certification Form
  Enrollment Form for Active & Satellite Employees (July 2011 - June 2012)
  Enrollment Form for Direct Pay Employees (July 2011 - June 2012)
  Enrollment Form for Retirees (July 2011 - June 2012)
  Health Benefits Personal Information Change Form
  HIPAA Authorization Form

  Personal Care Insurances
  MetLife PA&D Beneficiary Form
  MetLife Life Insurance Beneficiary Form
  MetLife Statement of Health Form
  UNUM Lifestyle and Long Term Disability Enrollment
  UNUM Lifestyle Plan Beneficiary Form
  UNUM Long Term Disability Claim Form

  Supplemental Retirement Plans
  403(b) Fidelity
  403(b) TIAA-CREF
  403(b) Voluntary Salary Deferral Agreement Form
  457(b) Fidelity
  457(b) TIAA-CREF
  457(b) Voluntary Salary Deferral Agreement Form

  Additional Benefits
  Commuter Choice Program
  Tuition Remission Form

• Compensation

  
  

  Job Candidate Travel Expense Reimbursement
  Position Description	Word version
  Request for Position Reclassification

• Contracts

  
  

  Adjunct Faculty Contract	Word version
  Contingent I Contract	Word version
  Contingent II Contract	Word version
  Graduate Assistant Contract	Word version
  Federal Work-Student Agreement Form	Word version
  Multiple Memo Pay Contract Renewal	Word version
  Request to Hire Contractual Employee*
  Student Assistant Employment Agreement*

  *Use Adobe Reader to fill in the forms before printing to ensure correct calculation. Forms calculate the contract amount using the start and end dates, hours per week, and hourly rate.

• Family Medical Leave Act (FMLA)

  
  

  FMLA Certification by Physician Form

  Employee Request for Family and Medical Leave

  Return to Work Medical Certification Form

  Key Provisions of FMLA

• Payroll and Tax

  
  

  311-T Change Form	Word version
  403B Deduction Form - TIAA-CREF
  457 Deduction Form - FIDELITY
  457 Deduction Form - TIAA-CREF
  Central Payroll Address Change Form
  Direct Deposit Authorization
  Maryland W-4 (Employee withholding allowance certificate)
  Maryland W-4 Instructions
  W-4 for Maryland Employees Residing in D.C.
  W-4 Supplemental Form for Non-Residents
  Part-time Faculty Payroll Authorization
  Part-time Faculty Payroll Authorization Change Notice
  SECU Direct Deposit Authorization

• Recruiting/Hiring

  
  

  Applicant Flow Data for Scheduled Interviews	Word version
  Candidate Travel Expense Reimbursement
  Employment Application	Word version
  HR Demographic Form (Employee Information Form)	Word version
  Interview Evaluation	Word version
  Personnel Requisition for Temporary Clerical Services
  Personnel Requisition	Word version
  Position Description	Word version
  Selection Criteria	Word version

• Retirement and Disability

  All forms and additional information can be obtained from the Maryland State Retirement and Pension System Participants website .

  Estimate Request Forms
  Estimate of Disability
  Estimate of Disability for Police Officers
  Estimate of Service Retirement
  Estimate of Service Retirement for Police Officers

  Retirement or Disability Retirement Applications
  Application for Service or Disability Retirement
  Preliminary Application for Disability Retirement

  General
  Application to be Placed on a Qualifying Approved Leave of Absence
  Designation of Beneficiary
  Direct Deposit for Retirees
  Election Not to Participate
  Federal and State Tax Withholding
  Reemployment After Retirement
  Reemployment After Retirement - Police Officers
  Request to Purchase Previous Service
  Retirement Credit Request for Active Military Service
  Statement of Disability