UTSA Human Resources Forms |
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Benefits |
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Benefits Cost Worksheet:
- UT Select Blue Cross Blue Shield - Evidence of Insurability Application [PDF]
- Short Term / Long Term Disability Application (Employees Only) [PDF]
- (CNA) Evidence of Insurability Long-Term Care, Short and Long Forms [PDF]
- Transitional Benefits Form [PDF]
- Assurant Dental Claim Form [PDF]
- Delta Dental Plan Claim Form [PDF]
- Medical Claim Form [PDF]
- Prescription Drug Reimbursement Form [PDF]
- Superior Vision Plan Claim Form
- Claim Form [PDF]
- Coordination of Benefits [PDF]
- Form to Request Extended Medication Supply [PDF]
- Mail Order Prescription Forms [PDF]
- PayFlex Direct Deposit Authorization Form - PayFlex Systems [PDF]
- PayFlex Give Yourself A Pay Raise! - PayFlex Systems [PDF]
- PayFlex Letter of Medical Necessity Form - PayFlex Systems [PDF]
- UT FLEX Claim Form - PayFlex Systems
- Salary Conversion Agreement [PDF]
- Employee & Spouse [PDF]
- Accidental Death & Dismemberment Certificate - Fort Dearborn Life [PDF]
- Group Term Life Certificate - Fort Dearborn Life [PDF]
- Fort Dearborn Life / PAI Brochure - Fort Dearborn Life Insurance [PDF]
- Fort Dearborn Life Beneficiary Designation Form - Fort Dearborn Life Insurance [PDF]
- Benefits Change Of Status Form [PDF]
- Benefits Dependent Form [PDF]
- Incapacitated Child Form [PDF]
- Insurance Enrollment/Change Authorization Form [PDF]
- Leave Without Pay
- Purchase Agreement: Unused Annual Leave Payment to 457 (b) [PDF]
- Waiver of Medical Insurance
- Zip Code Exception Form [PDF]
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Compensation |
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Employment |
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- Conflicts of Interest Policy Acknowledgement Form
- Criminal Background Check Form
- Direct Deposit Form [PDF]
- Employee Acknowledgement Form [PDF]
- Employment Offer Letter
- New Form I-9
- New Employee Information Request Form
- New Employee "On-the-Job" Orientation Checklist
- Notice of Voluntary Service
- Political Aid, Legislative Influence and Standards of Conduct [PDF]
- Request for Prior Approval Of Outside Employment
- Selective Service Registration
Requirement Form
- W-4 Form - 2009 [PDF]
- W-5 Form - 2009 [PDF]
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Employment Packets |
- Non-Benefits Eligible Employment Packet
- Occasional Employment Packet
- Part-Time / Temporary Employment Packet
- Work Study Employment Packet
- Required Reading Documents
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Mail Codes |
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FMLA |
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- Family Medical Leave Request Form
- Sick Leave Pool Form
- Physician Certification Form
- WH-384 Certification of Qualifying Exigency For Military Family Leave [PDF]
- WH-385 Certification for Serious Injury or Illness of Covered Service member -- for Military Family Leave [PDF]
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Performance and Evaluation |
- Probationary Employee
Evaluation
These online fillable forms require the macros to be Enabled in Word 2003 or 2007
For instructions click on the version of Word (above) you currently use.
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Position Management |
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Records Services |
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Retirement |
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- Authorization for Reduction for Employee Contribution [PDF]
- Authorization for Reduction for Employee Contribution For Employees Returning to ORP [PDF]
- Purchase/Change Agreement [PDF]
- Transfer Verification Form [PDF]
- Authorization to Change Carriers [PDF]
- Cancellation Request
- Purchase Agreement ORP/TSA
- Transfer Verification Form [PDF]
- UT System TSA Disclosure
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Separation / Termination |
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- NEW Employee Separation Process
- NEW Separation Processing Checklist [PDF]
- NEW Employee Separation Form [PDF]
- NEW Acceptance of Resignation Letter (Template)
- Purchase Agreement: Unused Annual Leave Payment to 457 (b) [PDF]
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Sick Leave Pool |
- Sick Leave:
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Training and Development |
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- Individual Sign-in Form [PDF]
- Course Sign-in Form [PDF]
- Course Evaluation Form [PDF]
- Class Scheduling Form [PDF]
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