Paper Forms
Electronic Forms
Paper Forms

Paper Forms

These forms are accessible using Adobe Acrobat Reader. These forms cannot be submitted electronically. They must be printed and submitted through the proper channels to Human Resources. However, forms marked with a red asterisk (*) are editable on-line. This means that you can complete them (type on them) via your computer but they cannot be submitted electronically. More forms will be made editable as time progresses.

Many forms are electronic and must be submitted through the E-form system. Electronic forms access is not given to everyone. If you need access to the forms, please contact your department head.

Form Purpose
Time Sheets Payroll Calendar Refer to the Payroll Calendar to ensure the correct dates are used on your timesheet.
HR 12- Student Submission of Student Hours Worked- Excel- Editable and it calculates for you!

HR 12- Non-Exempt

HR 12- Rebel Reserve

 Submission of Non-Exempt Employee Hours Worked- Excel- Editable and it calculates for you!
HR 12- Exempt Submission of Leave Time for Exempt Employees- Excel- Editable and it calculates for you!
HR 12- Student (Acrobat) Submission of Student Hours Worked
HR 12- Non-Exempt (Acobat) Submission of Non-Exempt Employee Hours Worked
HR 12- Exempt (Acrobat) Submission of Leave Time for Exempt Employees
Payroll W4* Employer can withhold the correct Federal income tax
MSTax* Employer can withhold the correct State income tax

IRS

8233

 Exemption from Withholding on Compensation for Independent Personal Services of a Nonresident Alien Individual
Beneficiary Information UNUM Name Beneficiaries for UNUM Life Insurance
PERS 1B Change Beneficiaries for Retirement
AETNA Change Beneficiaries for Aetna Life Insurance
UNUM 2 Change Beneficiaries for UNUM Life Insurance
AIG Change Beneficiaries for AIG Life Insurance
Claim Forms Delta Dental Insurance Claim form for Delta Dental
Colonial Insurance Claim form for Colonial Life and Accident
BCBS Insurance Claim form for BCBS
Catalyst Insurance Claim form for Prescriptions
Catalyst Mail Order Form for Mail Order Prescriptions
Request Request for Reimbursement Request for Reimbursement from Flexible Spending Accounts
Request for Transcript Request for Transcript from UM Registrar's Office
Agreement Salary Reduction Agreement Agreement that Employee's Salary will be reduced and the University will contribute the same amount to TSA(s) or Mutual Fund Carriers
Change of Information
PERS Change Change of Information for the Public Employees' Retirement System
Benefits Info Change Change of Information for Other Benefits
HR Forms Exit Checklist Must be completed on all employees who are leaving the University
Student Employee Exit Checklist Completed on student employees who are leaving the University
HR 9 Application for Permission to Engage in Outside Employment or Practice of Profession

FORM 13S
(Acrobat) (Word)

Supplement to the HR 13
HR 14 Donor Leave Request
HR 17 Application for Permission to Engage in Intra-University Employment
HR 19* Permission to take a Course(s) Under the University's Further Education Policy
HR 21 Medical Certification Form
HR 21S Supplemental Medical Certification Form
HR 22 Demographic Information
HR 24 Selective Service Eligibility and Verification
HR 31* Job Analysis Questionnaire (JAQ)- Exempt Position
HR 33* Job Analysis Questionnaire (JAQ)- Non- Exempt Position
HR 35* Minimum Qualifications Questionnaire
PERF PROB EX* Performance Appraisal for Exempt Employees (Probationary)
PERF PROB NON* Performance Appraisal for Non- Exempt Employees (Probationary)
Worker's Compensation

WORK COMP

Choice of Physician

Investigation Report

 Worker's Compensation- First Report of Injury or Illness

Supervisor's Workplace Injury Investigation Report
PERS PERS 4A Non Covered Employment Acknowledgment
PERS 4B Certification/Acknowledgment of Reemployment of Retiree
PERS 5 Application for Refund of Accumulated Contributions to Member
PERS CONTRACTOR Form to Be Completed For PERS Retirees Returning as Independent Contractors
PERS EMERGENCY REQUEST Form to Be Completed For Request For Emergency Waiver of 45 Days of Accumulated Contributions
PERS INFO Public Employees' Retirement System (PERS) Information
Veterans VETS Requirements for Veteran's Reporting
Notifications IMP NOTIF Important Notifications (6/15/01)
Reasonable Suspicion Record REASONABLE SUSPICION Reasonable Suspicion Record

For more information, please contact Human Resources at 662.915.7431.

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