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Forms A to Z

Following is an alphabetical listing of the Human Resource-related forms. To help in locating a form, some of the same documents are listed with multiple names. Click on the appropriate letter to locate the document you desire.

To search by area of interest, click here .

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A
Academic Leave Certification Form for Sick Leave
Accidental Death and Dismemberment Brochure
Address and/or Name Change Form - Employment Records
Address Change - La. State Employees' Retirement System
Address Change - Teachers' Retirement System of La.
Alien Tax Information Request Form
Annual Leave Accrual Rate Election Form

B (Return to Top)
Beneficiary and/or Name Change Form - Prudential Life Insurance
Beneficiary Change form - LSU First Life Insurance
Beneficiary Designation and Change Form - CSRS
Beneficiary Designation and Change Form - Prudential Life Insurance
Beneficiary Designation Form - La. State Employees' Retirement System
Beneficiary Designation Form - Teachers' Retirement System of La.
Beneficiary Designation Form - Louisiana Deferred Compensation Plan
Benefits Schedule Booklet

C ( Return to Top)
Calculator for Funded and Unfunded Service
Campus Federal Credit Union Payroll Deduction Form
Car Insurance Agreement-LCES
Civil Service Employment Application
Civil Service Position Description (SF-3) - PDF or Word
Coursework Request Form
CSRS Application for Retirement
CSRS Beneficiary Designation and Change Form
CSRS Refund of Contributions Application

D (Return to Top)
Deferred Compensation Plan Enrollment, Beneficiary Form, & Salary Deferral Agreement found HERE
Dental - Dearborn National Provider Nomination Form
Direct Deposit Form (Payroll Check)
Direct Deposit Waiver (Payroll Check)
Driver Record Verification and Vehicle Authorization Form
Drug Policy (Illegal Use Of) PS-18

E (Return to Top)
Employment in a Job Not Covered by Social Security (SSA-1945)
Employment of a Minor Form
Employment Packet Request -PDF
Employment Screening Form - PDF or Word
Ethics Training Flyer

Extension Benevolent Life Insurance - Beneficiary Designation
Extension Benevolent Life Insurance - Enrollment Form

F (Return to Top)
Faculty Job Description Form (PS-46) - PDF or Word
Family Medical Leave Act (FMLA) Notification Form
Family Medical Leave Act (FMLA) Medical Certification Form
Flexible Benefits Plan Medical FSA Claim Form - BoonChapman

Flexible Benefits Plan Dependent FSA Claim Form - BoonChapman

Flexible Benefits Plan Enrollment Form
Flexible Benefits Plan Status Change Form

G (Return to Top)
GB-01 - Group Benefits Enrollment/Change Form
GI-1 - Benefits Coverage While on Leave Without Pay Election Form

H ( Return to Top)
H1B Extension - Unit Instructions - PDF or Word
H1B New Petition - Unit Instructions - PDF or Word
Hartford Accidental Death and Dismemberment (AD and D) Enrollment Form
Hartford Accidental Death and Dismemberment (AD and D) Plan Features

Hartford Evidence of Insurability/Disability Form (Long-term Disability & Supplemental Life Ins)
Hartford Long-term Disability Claim Form
Hartford Long-term Disability Enrollment Form

Hartford Long-term Disability Plan Features

Hartford Supplemental Life Insurance (LSU System) Enrollment Form

Hartford Supplemental Life Insurance (LSU System) Beneficiary Change Form

Health Insurance Enrollment/Change Form (GB-01)

Health Insurance Portability Law Form
Housing Agreement

I (Return to Top)
I -9 Form - Employment Eligibility Verification Form
International Visitor - Request for Arrangements - PDF or Word
Interview and Selection Process
Interview Form - Extension Agent
Interview Selection Requirements for Agents

J (Return to Top)
J1 Exchange Visitor Extension - Unit Instructions - PDF or Word
J1 Exchange Visitor Obtaining Visa - Unit Instructions - PDF or Word

K (Return to Top)

L (Return to Top)
L-4 - Louisiana State Tax Form - Employee Withholding Certificate
L-4E - Louisiana State Tax Form - Exemption From Withholding
LASERS - LA State Employees' Retirement System Address Change
LASERS - LA State Employees' Retirement System Beneficiary Designation
LASERS - LA State Employees' Retirement System Enrollment Form
LASERS - LA State Employees' Retirement System Name Change Form
LASERS - LA State Employees' Retirement System Refund Contributions Form
LASERS - LA State Employees' Retirement System Refund Rollover Form
LASERS SSA-1945 (Employment in a job not covered by Social Security)
Leave Accrual Election Form
Leave Without Pay - Benefits Coverage Election (GI-1)
Letter of Demotion for Classified Employees (SAMPLE)

Letter of Resignation (SAMPLE)

Letter to Applicant not Selected for Position (SAMPLE)

Louisiana Deferred Compensation Plan Enrollment, Beneficiary Form, & Salary Deferral Agreement found HERE
LSU First Critical Illness Cash Benefit Claim Form
LSU First Life Insurance Beneficiary Designation Form
LSU System Voluntary Benefits Enrollment/Change Form

M (Return to Top)
Medical Certification

N (Return to Top)
Name and/or Address Change Form - Employment Records
Name and/or Beneficiary Change Form - Prudential Life Insurance
Name Change - La. State Employees' Retirement System
Name Change - Teachers' Retirement System of LA
Name Tag Information
New Employee Orientation Checklist
New Employee Orientation Schedule and Registration

O (Return to Top)
Offer Letter - Agent
Offer Letter - Associate
Offer Letter - Postdoctoral Researcher

Offer Letter - Professor (Research)

Offer Letter - Unclassified
Optional Insurance Election Form
Optional Retirement Plan (ORP) Enrollment/Change Form
Orientation Checklist for New Employees
Orientation Schedule & Registration Form
Outside Employment Disclosure Form - PM-11 Forms A & B

P (Return to Top)
Payroll Schedule 2010-2011 - Student
Payroll Schedule 2010-2011 - Wage

PER 1B - Personnel Action Form (Can use to attach Job Description in HRS) - PDF or Word
PER 17 - Turn Around Document
Performance Planning and Review - CS General - PDF or Word
Performance Planning and Review - CS Nutrition Educator - PDF or Word
Performance Planning and Review - CS Administrative (Clerical) Support - PDF or Word
Performance Evaluation Form - Associate/Postdoc Researcher - PDF or Word
Performance Evaluation Form - Non-Classified - PDF or Word
PM-11 Outside Employment Disclosure Forms A & B
PS-18 Illegal Use of Drugs or Alcohol
PS-37 Return to Work Following Illness or Injury
Portability Law - Health Insurance
Position Advertisement and Selection Record - PDF or Word
Position Description - Civil Service - SF-3 - PDF
Promotion/Tenure Review Request Form - Word or PDF
Prudential Life Beneficiary and/or Name Change Form
Prudential Life Beneficiary Designation and Change Form
Prudential Life Claim Form
Prudential Life Evidence of Insurability Form
Prudential Life Insurance Enrollment Form

Q (Return to Top)

R (Return to Top)
Research Associate Supplemental Job Description Form - PDF or Word
Retirement Election Form - Temporary or Part-time Employee
Retirement Eligibility Chart - All Systems
Refund of Contribuitons - Federal Civil Service Retirement System
Refund of Contributions - LASERS
Refund of Contributions - LASERS - Rollover Authorization
Refund of Contributions - Teachers' Retirement System of La.
Retirement - TRSL or ORP ... How Do I Choose?
Return to Work Policy (After Illness or Injury) - (PS-37)

S (Return to Top)
Sabbatical/Educational Leave Request Form
Schedule of Employee Benefits Booklet
Selective Service Verification Instructions
SF-3 - Civil Service Position Description - PDF or Word
Sick Leave Certification Form - Academic Employees
SSA.-1945 (Employment in a job not covered by SS)
SSA-1945-LASERS
SSA-1945-TRSL
Stop Payment Request
Student Employment Application
Student Employment - Intent to Employ a Minor
Student Timesheet - PDF or Word
Supplemental Employment Form
Supplemental Retirement Account Election/Salary Reduction Authorization Form
Supplemental Retirement Account - 457 and 403b Overview Info.
Supplemental Timesheet (Form AS420)
Supporting Documents Required for Appointments

T (Return to Top)
Tax Saver Flexible Benefits Plan Enrollment Form
Tax Saver Flexible Benefits Plan Status Change Form
Tax Saver Flexible Benefits Plan Medical FSA Claim Form

Tax Saver Flexible Benefits Plan Dependent FSA Claim Form

Tax Treaty (Form 8233)
Tax Treaty Example Sheet

Tax Withholding - Federal W-4
Tax Withholding - State L-4
Tax Withholding - State L-4E (Exemption From Withholding)
Tax Withholding Example for Non-Resident Aliens

TRSL Teachers' Retirement System of La. Address Change Form
TRSL Teachers' Retirement System of La. Beneficiary Designation
TRSL Teachers' Retirement System of La. Enrollment Form
TRSL Teachers' Retirement System of La. Name Change Form
TRSL Teachers' Retirement System of La. Refund of Contributions
TRSL Teachers' Retirement System of LA. SSA-1945 (Job not covered by SS)

Thrift Savings Plan Election/Change Form
Thrift Savings Plan Catch-Up Contribution Form
Timesheet - Bi-Weekly - PDF or Word
Timesheet - Student - PDF
Timesheet - Supplemental (Form AS420)
TN Canadian Status - Obtain TN Status and Employ
TN Canadian Status - Extend TN Status and Continue Employment
Turn Around Document (PER 17)

U (Return to Top)
UNUM Long term Care Brochure
UNUM Long term Care Enrollment Form
UNUM Long term Care Evidence of Insurability (E of I) Form
UNUM Long term Care Medicare Disclosure
UNUM Long term Care Policy Information
UNUM Long term Care Rates (3 year benefit)
UNUM Long term Care Rates (6 year benefit)
UNUM Long term Care Worksheet

V (Return to Top)
Vehicle Authorization and Driver Record Verification Form
Visa - H1B Extension - Unit Instructions - PDF or Word
Visa - H1B New Petition - Unit Instructions - PDF or Word
Visa - Extending J1 Exchange Visitor Status - Unit Instructions - PDF or Word
Visa - Obtaining J1 Exchange Visitor Status - Unit Instructions - PDF or Word
Visa - Extending TN Canadian Status - Unit Instructions
Visa - Obtaining TN Canadian Status - Unit Instructions

W ( Return to Top)
W-4 Federal Tax Form (Employee Withholding Certificate)
Worker's Compensation Notice of Compliance Poster
Worker's Compensation Incident/Accident Investigation Form
Worker's Compensation Employer Report of Injury/Disease
Worker's Compensation Medical Authorization Release - PDF or Word
Worker's Compensation Prescription Drug Benefits

X (Return to Top)

Y (Return to Top)

Z (Return to Top)

Related Files

Filename	Description	File Size
ADD.pdf		2,943.34 KB
lvcrtfrm.pdf		173.43 KB
alien.pdf		597.94 KB
Prudential+Benef+and-or+Name+Chg.pdf		31.14 KB
trbene.pdf		339.21 KB
prudentialbeneficiarydesignationchange.pdf		96.35 KB
ddwaiver.pdf		145.43 KB
SABBCML.PDF		709.32 KB
Intention+to+Employ+Minors.pdf		90.80 KB
studentapp.pdf		425.00 KB
PS46facjobdesc.pdf		20.03 KB
PS46facjobdesc.doc		106.50 KB
MedNot.pdf		31.57 KB
SSA-1945.pdf		481.13 KB
GB-01.pdf		1,698.54 KB
LongTermDisability.pdf		3,468.34 KB
LTD_EOIform.pdf		171.52 KB
insurportability.pdf		19.03 KB
raiv.pdf		581.29 KB
raiv.doc		51.50 KB
LCES+Faculty+Interview+05-04+(Fillinable).pdf		168.40 KB
L-4.pdf		26.80 KB
L-4E.pdf		49.64 KB
Lasers+Change+of+Name.pdf		34.02 KB
LASERS_SSA1945.pdf		2,535.56 KB
Prudential+Life+Ins+enrollment_kit.pdf		3,766.88 KB
Prudential+Life+ins+evidence_of_insurability_(eoi).pdf		288.39 KB
medcert.pdf		256.41 KB
nametag.pdf		60.21 KB
orientation+checklist.pdf		17.68 KB
orientation+checklist.doc		43.00 KB
Per17.pdf		680.28 KB
posann.pdf		10.09 KB
posann.doc		22.50 KB
PM-11.pdf		12,812.31 KB
ResAsocJD.pdf		1,954.42 KB
ResAsocJD.doc		35.50 KB
resign.pdf		349.00 KB
Refund+form.pdf		20.35 KB
as32.pdf		28.38 KB
teachret.pdf		1,029.62 KB
TRSL_SSA1945.pdf		89.44 KB
wcnotice.pdf		285.49 KB
InjuryReportFormWC1007.pdf		161.80 KB
ORM+Prescriptions.pdf		362.30 KB
ldcpinfo.pdf		126.21 KB
TRSLAddressChangeForm.pdf		22.29 KB
Dental-Vision+Plan+Continuation-COBRA.pdf		29.89 KB
Housing-Agreement.pdf		13.25 KB
Leave-Accrual-Selection-Form.pdf		65.87 KB
Address-Change-LASERS.pdf		318.85 KB
Coursework-Request-Form.pdf		195.83 KB
TRSL-vs-ORP.pdf		600.61 KB
Address-Change-Form.pdf		46.97 KB
J1-Instructions-to-Obtain-Visitor-Visa.doc		35.50 KB
J1-Instructions-to-Obtain-Visitor-Visa.pdf		17.37 KB
J1-Instructions-To-Extend-Visitor-Visa.pdf		188.77 KB
J1-Instructions-To-Extend-Visitor-Visa.doc		25.50 KB
Perf-Evaluation-NonClassified.pdf		119.34 KB
Perf-Evaluation-NonClassified.doc		98.00 KB
PPR--Clerical-Support-0206.doc		193.50 KB
PPR-General-0206.doc		192.50 KB
PPR-Nutrition-Educ-0206.doc		189.50 KB
PPR-Nutrition-Educ-0206.pdf		8,389.03 KB
Selective-Service-Registration.pdf		174.14 KB
PER1B.doc		31.00 KB
PER1B.pdf		9.94 KB
Ext-Benv-Beneficiary-Form.pdf		50.79 KB
Ext-Ben-Enrollment-Form.pdf		285.12 KB
Staff_Benefits-On-LWOP-GI-1.pdf		38.31 KB
SRA-Salary-Reduction-Form.pdf		50.30 KB
CSRS-Beneficiary-Form.pdf		178.74 KB
CSRS-Refund-Application.pdf		131.46 KB
Retirement-Election-Form.pdf		25.41 KB
LTD-Claim-Form.pdf		104.46 KB
sf3.pdf		156.60 KB
FacEmplAppli02-07.doc		136.50 KB
PPRAdministrativeClericalSupport0206.pdf		7,953.52 KB
FSA-Status-Change-Form.pdf		97.63 KB
ORPElectChangeForm.pdf		39.89 KB
Employment-Screening-Form.doc		121.50 KB
Employment-Screening-Form.pdf		132.83 KB
W4.PDF		224.70 KB
2006PTForm.pdf		91.26 KB
LASERS-Membership-Registration.pdf		330.85 KB
Lasers-Refund-of-Accum-Contributions.pdf		821.73 KB
Lasers-Refund-Author-for-Direct-Rollover.pdf		266.35 KB
UNUM-LTC-Brochure.pdf		170.75 KB
UNUM-LTC-EOI-Form.pdf		57.83 KB
UNUM-LTC-Medicare-Disclosure.pdf		17.33 KB
UNUM-LTC-Policy-Information.pdf		1,056.63 KB
UNUM-LTC-Rates-3-year-benefit.pdf		156.94 KB
UNUM-LTC-Rates-6-year-benefit.pdf		156.46 KB
UNUM-LTC-Worksheet.pdf		22.38 KB
Prudential-Life-Rates-Active-Age-70-and-up.pdf		69.33 KB
Prudential-Life-Rates-Active-and-Retired-Age65-69.pdf		71.49 KB
Prudential-Life-Rates-Retired-Age-70-and-up.pdf		69.98 KB
Prudential-Life-Rates-Act-and-Ret-Under-Age-65.pdf		71.05 KB
2007PTForm.pdf		187.50 KB
Timesheet-Student.doc		113.00 KB
Timesheet-Student.pdf		17.48 KB
Timesheet-Wage.doc		78.50 KB
Timesheet-Wage.pdf		124.41 KB
TN-Canadian-Instructions-To-Extend-Status.doc		70.50 KB
TN-Canadian-Instructions-To-Extend-Status.pdf		38.38 KB
TN-Canadian-Instructions-To-Obtain-Status.pdf		123.23 KB
Optional-Insurance-Election-Form.pdf		94.04 KB
Interview-Selection+Process+08-06.doc		131.00 KB
Letter+-+applicants+not+selected+03-05.doc		23.50 KB
Letter+of+offer+to+associates+-+postdoc+03-05.doc		23.00 KB
Letter+of+offer+academic.doc		25.50 KB
Letter+of+offer+to+unclassified.doc		22.00 KB
CSRS-Retirement-Application.pdf		1,277.98 KB
Orientation-Schedule-Registration-Form.pdf		118.65 KB
W.C.+Medical+Treatment+Authorization.pdf		11.80 KB
W.C.+Medical+Treatment+Authorization.doc		113.00 KB
H1B1-Extension-Instructions.doc		108.00 KB
H1B1-Extension-Instructions.pdf		26.70 KB
H1B1-New-Petition-Instructions.doc		465.50 KB
H1B1-New-Petition-Instructions.pdf		67.06 KB
directdeposit.pdf		526.79 KB
Perf-Evaluation-Associate-Postdoc-03-08.doc		114.50 KB
Perf-Evaluation-Associate-Postdoc-03-08.pdf		75.87 KB
2008+PT+Form.doc		55.00 KB
2008+PT+Form.pdf		162.50 KB
Faculty+Job+Description.doc		103.50 KB
Faculty+Job+Description.pdf		116.69 KB
Prudential+Life+Claim+Form.pdf		757.30 KB
Supplemental-Timesheet+(Form+AS420).pdf		267.41 KB
Exit-Checklist.pdf		19.96 KB
LSU-First-Life-Beneficiary-Change-Form.pdf		256.37 KB
TRSL+Name+Change+Request.pdf		55.02 KB
LSUFirst-flyer.pdf		509.33 KB
LSUFirst-Critical-Illness.pdf		259.12 KB
The+Hartford+-+Enrollment+Form.pdf		206.10 KB
The+Hartford+-+Beneficiary+Change+Form.pdf		73.44 KB
Thrift+Savings+Plan+Election+or+Change+Form+-+TSP-1.pdf		53.17 KB
Thrift+Savings+Plan+Catch-Up+Contribution+Election+TSP-1c.pdf		31.30 KB
Retirement+Eligibility+Chart+-+All+Systems+2009.pdf		114.05 KB
Folder+1+-+Insurance+Agreement+for+LCES+Employees.pdf		64.28 KB
The+Hartford+-+Evidence+of+Insurability.pdf		91.60 KB
LTD+Plan+Features+-+Info+Only.pdf		3,481.42 KB
Supporting-Documents-Required-For-Appointments.pdf		89.06 KB
Employment+Packet+Instructions+-+Folder+5+ALL+NON+U.S+CITIZENS.pdf		30.62 KB
Folder+5+-+EXAMPLE+-+8233+and+Attachment.pdf		623.87 KB
Folder+5+-+W-4+L-4+Example+Sheet.pdf		371.77 KB
457+and+403b+Overview+Information+2009.pdf		219.21 KB
Position+Advertisement+and+Selection+Record.doc		69.50 KB
Position+Advertisement+and+Selection+Record.pdf		123.49 KB
Demotion+Letter+for+Classified+Employees.doc		23.50 KB
UNUM+Acknowledgement+of+Dislosure+of+Rating+Practices.pdf		49.91 KB
Dearborn+National+Provider+Nomination+Form.pdf		488.79 KB
The+Hartford+-+Enrollment+Form+Supplemental+Life.pdf		115.58 KB
Interview+and+Selection+Requirements+for+Agent+Positions.pdf		32.95 KB
LCES+Internship+Application+2010.doc		128.00 KB
Forms-Processing-Guidelines.pdf		99.44 KB
Retirement+Calculator,+Funded+and+Unfunded.xlsx		13.05 KB
ORP+-+Retirement+with+Resignation+Form.doc		95.00 KB
Employment+Packet+Request.pdf		121.54 KB
Dental+Plan+-+Basic+-+Benefit+Highlights.pdf		270.61 KB
Dental+Plan+-+Enhanced+-+Benefit+Highlights.pdf		271.50 KB
Dental+Services.pdf		75.87 KB
Vision+Plan+Info+(LSU+First+participants).pdf		111.88 KB
Vision+Plan+Info+(Non-LSU+First+participants).pdf		111.95 KB
Campus+Federal+Payroll+Deduction.pdf		300.43 KB
Supp+Employment+Form+fill+in+05-05.pdf		200.56 KB
PPRGeneral+Fill-in.pdf		6,853.07 KB
UNUM+LTC+Enrollment+Form.pdf		55.38 KB
Instructions+for+online+enrollment+CHANGEPLAN.doc		28.50 KB
Boon+Chapman+DIRECT+DEPOSIT.pdf		47.30 KB
2011+Health+Plan+Comparison+and+Summary.pdf		332.65 KB
Davis+Annual+Enrollment+Slide+Show.pdf		340.04 KB
Davis+Handout+-+AE.pdf		189.52 KB
LSU+First+-+Preventive+Health+Coverage.pdf		8,873.25 KB
LSU+First+-+Chronic+Health+Condition+Brochure.pdf		2,387.16 KB
Incident+Accident+Investigation+Form+1.pdf		14.37 KB
Prescription-Drug-Benefit-Administrators.docx		16.16 KB
Employment-Packet-Instructions---Folder-1.pdf		129.66 KB
BoonChapman-Medical-FSA-Claim-Form.doc		110.00 KB
BoonChapman-Dependent-FSA-Claim-Form.doc		110.50 KB
Instructions-for-online-enrollment-FLEX.doc		29.00 KB
Annual-Enrollment-for-Active-Employees.doc		26.00 KB
LSU-Vol.-Benefits-Enrollment-Change-form.pdf		306.25 KB
PPRGeneral.pdf		7,263.52 KB
PPRAdminClericalSupport.pdf		7,468.62 KB
PPRNutritionEducator.pdf		137.48 KB
PPRGeneralFill.pdf		7,054.51 KB
PPRAdminClericalSupportFill.pdf		7,459.87 KB
PPRNutritionEducatorFill.pdf		135.60 KB
FSA-ENROLLMENT-FORM.pdf		20.92 KB
sf3.doc		89.50 KB
Offer-Letter---Professorial-Ranks,-Research.docx		29.32 KB
Ethics-Training-Flyer.pdf		40.54 KB

Last Updated: 5/22/2012 8:49:31 AM

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