Forms

Health, Dental, and Vision Benefits

PEEHIP – Instructions for New Enrollment
PEEHIP Premium Assistance (Premium reduction is based on income & number of dependents)
PEEHIP Healthcare Provider Screening Form
PEEHIP New Enrollment and Status Change Form
PEEHIP Address Change Notification

Important Notices

Health Insurance Marketplace Coverage

Retirement Plan

TRS Retirement Application (Active)
TRS Change of Beneficiary

Flexible Spending Plan

Health Reimbursement Accounts – Health Equity
Dependent Care Claim – Health Equity

Family Medical Leave Act

FMLA Form WH380E (Certification of Health Care Provider for Employee’s Serious Health Care Condition)
FMLA Form WH380F (Certification of Health Care Provider for Family Member’s Serious Health Care Condition)
FMLA Form WH381 (Notice of Eligibility and Rights & Responsibilities)
FMLA Form WH383 (Designation Notice)
FMLA Form WH384 (Certification of Qualifying Exigency for Military Family Leave)
FMLA Form WH385 (Certification for Serious Injury or Illness of Covered Service member for Military Family Leave)
FMLA Poster

Additional Forms

Leave Form
Sick Leave Bank, Notice for Participation
Sick Leave Bank, Application for a Loan
Tuition Waiver Form – Athens State and ACCS Employees & Eligible Dependents

A-4, Alabama Department of Revenue Tax Form Withholding Certificate
W-4, IRS Withholding Certificate
Direct Deposit Form
I-9 Employment Eligibility Verification
Address Change
Overtime Approval Form

Job Description Sample

Job Search Request

ADA – Job Accommodation Worksheet
ADA – Job Accommodation Procedure
ADA – Release of Information
Equal Employment Opportunity Poster
Child Labor Law Poster
Equal Employment Opportunity Poster Supplement
Minimum Wage Poster
Minimum Wage Poster
Pay-Transparency Statement Poster
Right to Work Poster (English/Spanish)
Veterans’ Rights Poster
E-Verify

Foundation Contribution Deduction Form
Grievance Form A

Employee Suggestion Program

Guidelines
Employee Suggestion Form
Suggestion Evaluation Form

Presidential Award for Meritorious Performance

Guidelines
Nomination Form

Staff Emeritus Recommendation

Faculty Self-Evaluation Form
Faculty Evaluation Form (by Dept. Chair or College Dean)
Performance Evaluation Form (Staff)
Professional Development Plan for Non-Exempt Employees
Sexual Harassment Training Instructions
Ethics Training Instructions
Clery Act Training Instructions

Background Check, Consent Form
Employee Separation Checklist
Employee Transfer Checklist
Family Relationship Disclosure Form
New Employee Orientation Checklist
New Employee Checklist: Full-Time
New Employee Checklist: Part-Time
Personal Data Form
Notification of Secondary Employment
Policies – Acknowledgement Form
Statement of Economic Interests
Survey – New Employee Orientation
Teacher Retirement System Record Update

Confidentiality Form PDF (For Student Employees Only)
Retiree Notice of Postretirement Employment