Forms Listing by Function and Title

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: 4/2011
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: 9/2010
This is the signed authorization for an employee/visitor's UCAR access control card.
Casual Request Form	Added: 1/2005
Used to request a Casual Pool Administrative Assistant from the Casual Pool Coordinator.
CIGNA Authorization for Use and Disclosure of Private Health Information Form	Last Revised: 4/2003
Used by an employee requesting assistance from Human Resources on specific claims.
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: 11/2011
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: 6/2003
Used to report expenses incurred during a dental visit.
CIGNA Medical Claim Form	Added: 12/2001
Used to report expenses incurred during a medical visit.
CIGNA Prescription Claim Form	Added: 5/2004
Used to report Prescription Expenses for those employees with CIGNA PPO insurance plan
CIGNA Tel-Drug Mail Order Form	Added: 12/2001
To order a 90-day supply of a maintenance prescription.
Conflict of Interest Form	Added: 3/2008
The Conflict of Interest form is completed upon hire and updated annually by all employees.
Donation of Hours Form	Added: 1/2004
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	Added: 1/2004
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	Added: 4/2011
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	Added: 4/2003
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: 11/2009
Provides a checklist of 5 steps a hiring supervisor follows to complete the hiring process.
Intellectual Property Form	Last Revised: 11/2011
Used to satisfy the requirements of the UCAR Cooperative Agreement with the National Science Foundation.
Interview Documentation Form	Added: 1/2010
The hiring supervisor completes the Interview Documentation form to summarize the results of interviews during 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.
Performance Appraisal Form	Last Revised: 3/2011
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: 4/2011
Annual performance appraisals for Ladder Track Scientists and Research Engineer employees.
Personnel Profile Change Form	Last Revised: 3/2006
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: 3/2010
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.
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.
Separation Notice Form	Last Revised: 9/2009
Required document to notify UCAR Human Resources of an employee's departure.
Smart Choices Enrollment Form	Last Revised: 1/2011
Those UCAR employees needing a hard copy of the enrollment form.
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--2012	Added: 11/2011
The 2012TIAA/CREF Election Change Form is used to increase or decrease the amount of additional contribution to the employee's TIAA/CREF Retirement plan for 2012.
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:  10/2011
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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