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HRM Forms by Name (in alphabetical order)Instructions or Information about form 
2015 Dental Enrollment FormDental Insurance with UnitedHealthCare 
2015 Vision Enrollment FormVision Insurance with UnitedHealthCare 
2015 Voluntary Financial Protection Enrollment FormSupplemental Benefits
403(b) Enrollment with ING *Contact ING RepresentativeSupplemental Retirement 
403(b) Enrollment with MetLife *Contact MetLife RepresentativeSupplemental Retirement 
403(b) Enrollment with VALIC *Contact VALIC RepresentativeSupplemental Retirement 
403(b) Enrollment Contract with TIAA-CREF & Salary Reduction AuthorizationBoth forms must be submitted to begin enrollment. 
403(b) Salary Reduction Authorization FormSupplemental Retirement 
403(b) Withdrawal Election FormThis form must be submitted with vendor paperwork. 
457(b) Address, Name, or Information Change FormSupplemental Retirement 
457(b) Beneficiary Designation/Change FormSupplemental Retirement 
457(b) Enrollment Form with Louisiana Deferred CompensationSupplemental Retirement 
457(b) Salary Deferral Agreement with Louisiana Deferred CompensationSupplemental Retirement 
Aetna Nomination FormLSU First will reach out to a physician to join if they are not in the Aetna network. 
Academic Contract (PER-25)  
Academic Employees Request for 12 ChecksMust be submitted prior to first academic check of the year. 
Accidental Death & Dismemberment (AD&D) Claim FormAccidental Death & Dismemberment (AD&D) 
Accidental Death & Dismemberment (AD&D) Conversion FormAccidental Death & Dismemberment (AD&D) 
Accidental Death & Dismemberment (AD&D) Enrollment/Change  FormMust enroll within first 30 days of employment or as a late applicant and be medically underwritten. 
Adding Dependent/Spouse to Insurance Plan(s)Benefits 
Address ChangeChanging/Updating address with LSU and insurance providers. 
Authorization Agreement for ACH Insurance Deductions (Retirees only)Retirees 
Background Check Authorization FormOnly for positions not posted on Applicant Tracking. 
Blue Cross Blue Shield Claim Form for HMO & PPOHealth Insurance: Blue Cross Blue Shield 
Blue Cross Blue Shield (Catamaran ) Prescription Claim Form         for HMO & PPOHealth Insurance: Blue Cross Blue Shield 
Business Manager Certification Program ApplicationHR Contact and Business Manager Certification Program 
Business Manager Certification Program TranscriptHR Contact and Business Manager Certification Program 
Change of AddressChanging/Updating address with LSU and insurance providers. 
Civil Service Position Description (SF-3)  
Classified Performance EvaluationPS-39 
Coaching FormPositive Discipline 
Continuation of Benefits for Employees on LWOP - G1-1Use if continuing benefits while on Leave Without Pay. 
Crisis Leave Donation FormCrisis Leave Policy 
Crisis Leave Request FormCrisis Leave Policy 
Dearborn National Nomination FormDental Insurance 
Dependent Care Spending Account Claim FormFlexible Spending & Dependent Care Spending Accounts 
Dependent Care Spending Account Enrollment FormMust enroll during first 30 days of employment or during Annual Enrollment. 
Dental Enrollment/Change FormMust enroll during first 30 days of employment or during Annual Enrollment. 
Dental Claim FormDental Insurance 
Direct Deposit FormSubmit only if unable to complete online (not common). 
Drug Policy AcknowledgementSubmit only if unable to complete online (not common). 
Dual Certification Program TranscriptHR Contact and Business Manager Certification Program 
Employee Information Sheet & Loyalty OathSubmit only if unable to complete online (not common). 
Exit ChecklistFor department use only. 
Express Scripts (LSU First) Prescription Claim FormHealth Insurance: LSU First 
FMLA - Family Medical Leave Act FormFMLA Employee Rights 
FMLA Military Caregiver Leave FormFMLA Employee Rights 
FMLA Qualifying Exigency Leave FormFMLA Employee Rights 
Faculty Annual Evaluation TemplateThis form may be used as is or departments may create own form using elements of template. 
First Decisional Conference FormPositive Discipline 
Flexible Spending Account Continuation/Cancellation Form  (for LWOP) - G1-1 FlexUse if continuing/canceling flex benefits while on Leave Without Pay. 
Flexible Spending Account Direct Deposit FormFlexible Spending & Dependent Care Spending Accounts 
Flexible Spending Account Enrollment FormMust enroll during first 30 days of employment or during Annual Enrollment. 
Flexible Spending Account Expense Estimation Worksheet for Unreimbursed Healthcare CostsFlexible Spending & Dependent Care Spending Accounts 
Flexible Spending Account Claim Form (Healthcare)Flexible Spending & Dependent Care Spending Accounts 
GB-01 - Health Insurance Enrollment/Change FormMust enroll within first 30 days of employment or as a late applicant. 
Grievance FormPS-80 
HIPAA Form  
HR Contact Certification Program ApplicationHR Contact and Business Manager Certification Program 
HR Contact Certification Program TranscriptHR Contact and Business Manager Certification Program 
Health Insurance Enrollment/Change FormMust enroll within first 30 days of employment or as a late applicant. 
Hire Above Entry Pay Justification Form  
I-9 Immigration Employment EligibilityI-9 Tutorial 
ING EZ Enrollment Retirement Program Enrollment FormSupplemental Retirement 
Job Description Template

Job Description Sample

List of Competencies 

List of Action Verbs

 
L-4 Louisiana Employee Withholding*Payroll 
LASERS Address Change for Active EmployeesLASERS Retirement 
LASERS Beneficiary Change FormLASERS Retirement 
LASERS Certification of Continued Employment After DROP ParticipationLASERS Retirement 
LASERS Name Change for Active EmployeesLASERS Retirement 
LASERS Refund FormLASERS Retirement 
LASERS Rehired Retiree Information and Acknowledgment FormLASERS Retirement 
LSU First Claim FormHealth Insurance: LSU First 
LSU First Critical Illness Direct Cash Benefit FormHealth Insurance: LSU First 
LSU First Medical Claim FormHealth Insurance: LSU First 
LSU First Prescription Claim Form (Express Scripts)Health Insurance: LSU First 
Leave Accrual Rate ElectionSubmit only if unable to complete online (not common). 
Leave Slip ApplicationPS-12 Leave Guidelines 
Long Term Disability Conversion FormLong Term Disability 
Long Term Disability Claim FormLong Term Disability 
Long Term Disability Enrollment/Change FormMust enroll within first 30 days of employment or as a late applicant and be medically underwritten. 
Long Term Disability Evidence of Insurability ApplicationLong Term Disability 
Life Insurance - LSU System/The Hartford  
Life Insurance Beneficiary Designation/Change Form - The HartfordLife Insurance 
Life Insurance Cancellation Form - The HartfordLife Insurance 
Life Insurance Claim Form - The HartfordLife Insurance 
Life Insurance Conversion Form - The HartfordLife Insurance 
Life Insurance Enrollment Form - The HartfordMust enroll within first 30 days of employment or as a late applicant and be medically underwritten. 
Life Insurance Evidence of Insurability Form - The HartfordLife Insurance 
Life Insurance Name/Address Change Form - The HartfordLife Insurance 
Life Insurance Portability Application Form - The HartfordLife Insurance 
Life Insurance - Prudential  
Life Insurance Beneficiary Designation/Change Form - PrudentialLife Insurance 
Life Insurance Cancellation Form - PrudentialLife Insurance 
Life Insurance Conversion Form - PrudentialLife Insurance 
Life Insurance Enrollment Form - PrudentialMust enroll within first 30 days of employment or as a late applicant and be medically underwritten. 
Life Insurance Evidence of Insurability Form - PrudentialLife Insurance 
Life Insurance Health Statement Questionnaire - PrudentialLife Insurance 
Life Insurance Name/Address Change Form - PrudentialLife Insurance 
Life Insurance Portability Application Form - PrudentialLife Insurance 
  
Long Term Care Enrollment FormMust enroll within first 30 days of employment or as a late applicant and be medically underwritten. 
Long Term Care Evidence of Insurability ApplicationLong Term Care 
Long Term Care Cancellation FormLong Term Care 
Long Term Care Portability FormLong Term Care 
Louisiana Deferred Compensation Address, Name, Information Change FormDCCL Retirement 
Louisiana Deferred Compensation Beneficiary Designation/Change FormDCCL Retirement 
Louisiana Deferred Compensation Enrollment FormDCCL Retirement 
Louisiana Deferred Compensation Salary Deferral AgreementDCCL Retirement 
Name ChangeChanging/Updating address with LSU and insurance providers. 
New Hire ChecklistFor department use only. 
Office of Group Benefits - Enrollment/Change Form (GB-01) FormBenefits 
ORP Enrollment with ING *Contact ING RepresentativeORP Retirement 
ORP Enrollment with TIAA CREF Form *See Instruction columnThis form must be submitted with the ORP Enrollment Form. 
ORP Enrollment with VALIC *Contact VALIC RepresentativeORP Retirement 
ORP Rehired Retirees Information and Acknowledgment FormORP Retirement 
Outside Employment of University EmployeePM-11 
PPO Claim FormHealth Insurance: Blue Cross Blue Shield PPO 
PPO Prescription Claim FormHealth Insurance: Blue Cross Blue Shield PPO 
Performance Management Core Competencies - Employees  
Performance Management Core Competencies - Supervisors  
Performance Management Log  
Performance Management Planning & Evaluation Form  
Premiums Only Plan Enrollment/Change FormMust enroll during first 30 days of employment or during Annual Enrollment. 
Professional/Unclassified Contract (PER-40)  
Professional EvaluationPS-35 
Professorship Award Selection Form  
Promotion & Tenure Request FormInstructions on Promotion & Tenure Request 
Provost Advisory Committee Form  
Relocation Authorization FormFor department use only. 
Relocation Incentive AgreementRelocation Incentive Policy 
Request for Duplicate Tax Forms (W-2, 1042-S)Submit to Payroll. 
Request for Recommendation from Provost Advisory CommitteeUsed by department when hiring a new faculty member with tenure. 
Resignation/Separation Form  
Sabbatical Leave Request FormInstructions for Sabbatical Leave Request 
Second Decisional Conference FormPositive Discipline 
Salary Reduction AuthorizationSupplemental Retirement 
Status Change FormBenefits 
TRSL Address Change for Active EmployeesTRSL Retirement 
TRSL Address Change for RetireesTRSL Retirement 
TRSL Beneficiary Designation/Change FormTRSL Retirement 
TRSL Name Change for Active EmployeesTRSL Retirement 
TRSL Refund Request FormTRSL Retirement 
TRSL Rehired Retirees Information and Acknowledgment FormTRSL Retirement 
TRSL Retiree Return-to-Work NotificationUsed by a retiree returning to work in a TRSL-eligible position. 
Temporary Civil Service Appointment Form  
Vantage Claim FormHealth Insurance: Vantage 
Vision Enrollment/Change FormMust enroll during first 30 days of employment or during Annual Enrollment. 
Vision Claim FormVision Insurance 
Voluntary Benefits Enrollment/Change FormSupplemental Benefits 
Voluntary Self Identification of Disability Form  
W-4 Employee Withholding Allowance Certificate*Payroll 
Waiver of Advertisement RequestPS-1 

 

 

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Form directions and/or additional information are provided in the Instructions or Information column or within the form.

 

Forms that are submitted HRM can be scanned and emailed (unless original documents are required for processing) to hr@lsu.edu or sent via campus mail to 110 Thomas Boyd Hall.

 

For technical support on forms, contact an HR Generalist at 225-578-8200 or  hr@lsu.edu.