UCAR Finance & Administration

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Human Resources Forms

Affidavit of Common Law Marriage or Domestic Partnership Added:  10/2007
Used to certify an employee is in a relationship or partnership other than marriage recognized by the State of Colorado.
Applicant Affirmative Action Information Form Last Revised: 1/2009
This form should be provided to interviewees during the interview process.
[UCAR] Beneficiary Change Form Added: 7/2005
The UCAR Beneficiary Change Form is used to make any changes that affect an employee's beneficiary designations for Life Insurance, Travel AD&D, Basic AD&D, and Optional AD&D. Instructions are included to change TIAA-CREF beneficiaries online.
[UCAR] Benefit Change Form Last Revised: 1/2013
The UCAR Benefit Change Form is used to make any changes that affect an employee's health insurance coverage, and/or changes in flexible spending contributions or Health Savings Account.
Card Access Form Last Revised: 6/2014
This is the signed authorization for an employee/visitor's UCAR access control card.
Casual Request Form Last Revised: 3/2013
To request a Casual Pool Administrative Assistant by providing details of the work assignment to the Casual Pool Coordinator.
CIGNA Choice Fund Health Savings Account  – Automatic Claim Forwarding Election/Change Form Added:  11/2006
Enrollment in or termination of the automatic claims forwarding program
CIGNA Choice Fund Health Savings Account – JP Morgan Chase Bank Enrollment Form Last Revised: 2/2014
Employee authorizes JP Morgan Chase Bank to set up a savings account for depositing pre-tax contributions toward a CIGNA Choice Fund Health Savings Account (HSA)
CIGNA Choice Fund Health Savings Account – [UCAR] Payroll Authorization Last Revised: 11/2006
Employee authorizes UCAR to deduct the designated pre-tax contributions toward a CIGNA Choice Fund Health Savings Account (HSA)
CIGNA Dental Claim Form Last Revised: 2/2012
Used to report expenses incurred during a dental visit.
CIGNA Medical Claim Form Last Revised: 2/2012
Used to report expenses incurred during a medical visit.
CIGNA Prescription Claim Form Last Revised: 6/2013
Used to report Prescription Expenses for those employees with CIGNA PPO insurance plan
Cigna Home Delivery Pharmacy Last Revised: 1/2013
To order a 90-day supply of a maintenance prescription.
Conflict of Interest Form Last Revised: 2/2013
The Conflict of Interest form is completed upon hire and updated annually by all employees.
Donation of Hours Form Last Revised: 7/2013
The Donation of Hours Form is used to voluntarily donate accrued PTO or traditional vacation hours to fellow employees who may deplete their own PTO or traditional vacation leave due to unusual medical circumstances.
Donation Request Form Last Revised: 7/2013
The Donation Request Form is used by employees requesting donated leave hours.
Driving on UCAR Business Policy Last Revised: 10/2009
Must be completed before an offer of employment can be made for a position where driving a UCAR vehicle is a requirement.
Education Assistance Program Application Form Last Revised: 3/2011
The employee completes the Education Assistance Program application to seek the approval for a degree program or individual courses.
Employee Evaluation of Supervision

Added: 3/2001

This optional form is a tool which may be used for several purposes.  See the Form Details page.
Employee Tax Certification Form Added: 12/2009
The Employee Tax Certification form is used when determining whether Educational Assistance Program courses are taxable or non-taxable per Internal Revenue Code
Exit Interview Added: 7/2002
To solicit information from terminating employees on their experience with UCAR.
Export License Review Worksheet Added: 4/2011
Use this form to maintain documentation pertaining to a foreign employee's need for an Export License.
Five Year Career Planning
Added: 3/2001
Two forms are listed here:  Five Year Career Personal Development form and My Five Year Career Personal Development Plan form.  See details page for more information on using these two forms.
H-1B/I-129 Export License Certification Form Last Revised: 4/2013
To indicate whether or not a license is required when filing any H-1B visa application on Part 6 of Form I-129.
HIPAA Privacy Rights Forms Last Revised: 10/2013
This series of forms allows employees to make certain requests pertaining to their Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rights.
Hiring Process Road Map Last Revised: 6/2013
Provides a checklist of 5 steps a hiring supervisor follows to complete the hiring process.
Joint Appointment Memorandum of Understanding (MOU) Form Last Revised: 3/2010
This MOU is completed when an employee's time is allocated to two or more entities ...
New Employee Orientation Checklist
Last Revised: 2/2012
Hiring supervisor should review this checklist with a new employee.
Nonresident Alien Statement of Reduced Withholding Form Last Revised: 12/2010
This form must be completed by anyone on J or F visa who is eligible to claim tax exemption. 
Paladina Health Enrollment Form Added: 5/2014
Cigna High Deductible Health Plan (HDHP) participants use
this form to enroll in Paladina Health.
Performance Appraisal Form Last Revised: 2/2013
Formal performance appraisals occur annually according to a prescribe schedule of review dates. Each supervisor annually prepares a written evaluation of the performance of each employee reporting to him or her. Evaluations should include a discussion of the strengths and weaknesses of the employee's performance and steps by which the employee's performance can be improved. 
Performance Appraisal Form / Ladder Track Scientists and Research Engineers Last Revised: 2/2013
Annual performance appraisals for Ladder Track Scientists and Research Engineer employees.
Personnel Profile Change Form
Last Revised: 12/2013
The Personnel Profile Change Form is used to make any changes that affect an employee's position, program allocations, or profile information.
Position Description (PD) Last Revised: 3/2013
The PD is completed by the supervisor and asks for the signed concurrence of the employee. Instructions for completing the PD are attached to the questionnaire. The duties section is particularly important for reclassification requests. It should describe current job duties. A "Y" should be placed in the last column if the duty is new to the job since the last job description of record. 
Postdoctoral Fellow/Researcher Performance Appraisal and Plan Created: 4/2013
To provide feedback on performance and to support research and career development planning for Postdoctoral Fellows and Postdoctoral Researchers. Reference Postdoctoral Guidelines.
Reclassification Action Form Last Revised: 1/2011
The Reclassification Form, completed by the supervisor, requests information about the employee's current job classification, rationale for change, and appropriate Division/Program approvals. Please note that reclassification requests cannot be reviewed without the Division/Program Director's approval. 
Recovery of Corporate Property Form Last Revised: 7/2008
The Recovery of Corporate Property Form, completed by the employee (or the supervisor under some circumstances), is used to identify and return all equipment, property and/or monies or other UCAR items assigned to employees or visitors. 
Reference Check Form Last Updated: 12/2011
This form is to serve as a guide for checking an applicant's references before making a job offer.
Return of Mistaken Distribution from Health Savings Account Added: 9/2007
To return funds to the Health Savings Account that were removed in error.
Salary Access and Use Acknowledgement Form Added: 11/2012
Required authorization form to ensure that relevant employees do not disseminate or access salary data except for business reasons.
Separation Notice Form Last Revised: 2/2012
Required document to notify UCAR Human Resources of an employee's departure.
TIAA/CREF Beneficiary Change Form Added: 2/2005
The TIAA/CREF Beneficiary Change Form is used to change the employee's beneficiary(ies) listed on their TIAA/CREF Retirement plan.
TIAA-CREF Election Change Form - 2014 Last Revised: 1/2014
The 2014 TIAA/CREF Election Change Form is used to increase or decrease the amount of additional contribution to the employee's TIAA/CREF Retirement plan for 2014.
Visa Information: H-1B Visa Last Revised: 4/2008
The Temporary Worker (H-1B) visa is usually granted for an initial period of up to three years, may be extended to up to a total of six years, and may be changed to a different type of visa at any time. Recipients are not subject to a requirement of foreign residency before applying for another type of visa to this country. This visa may take several months to obtain.
Visa Information: J-1 Visa Last Revised: 4/2008
The Exchange Visitor (J-1) visa may be granted for up to three years. Exchange Visitors are subject to a two-year residence requirement in their country of nationality or last foreign residence before applying for another type of U.S. visa, unless the requirement is waived by the Immigration and Naturalization Service. Normally, the J-1 visa may be obtained in a few days, but it may take considerably longer in certain countries.
Visitor Forms Last Revised: 3/2013
The appropriate form must be completed for all new appointees, and revisions or extensions of current appointees.
WageWorks Commuter Benefits Claim Form Added: 1/2009
Allows reimbursements from the WageWorks Commuter Benefits Account. Plan effective 1/1/09.
WageWorks Dependent Care Flexible Spending Account Claim Form Added: 1/2009
Allows reimbursements from the WageWorks Dependent Care Flexible Spending Account. Plan effective 1/1/09.
WageWorks Flexible Spending Direct Deposit Authorization Added: 1/2009
Allows direct deposit of health care and/or dependent care reimbursements into the employee's designated account
WageWorks Health Care Flexible Spending Account Claim Form Added: 1/2009
Allows reimbursements from the WageWorks Health Care Flexible Spending Account. Plan effective 1/1/09.
W-4 Form Last Revised: 1/2012
This form is required so that UCAR can withhold the correct Federal income tax from your pay.

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