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HRM Forms A - Z

 

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HRM Forms by Name (in alphabetical order)Instructions or Information about form
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.