Forms for all Employees

Benefits Forms

• Qualified Status Change(pdf)
• Affidavit of Internal Revenue Service (IRS) Dependent Status for 2012(pdf)
• Affidavit of Internal Revenue Service (IRS) Dependent Status for 2012 (Life Insurance Only)(pdf)
• Affidavit of Same-Sex Domestic Partnership(pdf)
• Affidavit of Termination of Same-Sex Domestic Partnership(pdf)
• Medical Plan Fitness Reimbursement Forms (pdf)
  • Tufts Health Plan: Fitness Reimbursement Form(pdf)
  • Harvard Pilgrim Health Care: Fitness Reimbursement Form(pdf)
  • Fallon Community Health: Fitness Reimbursement Form(pdf)
• Employee Health Insurance Responsibility Disclosure Form 2012(pdf)
• Dependent Care Reimbursement Request Form(pdf)
• Tuition Reimbursement & Remission Forms
  • Staff Tuition Reimbursement – Benefit Application(pdf)
  • Staff Tuition Reimbursement – Request for Payment Form(pdf)
  • Staff Tuition Reimbursement – Document Guide(pdf)
  • Tuition Remission: Application Form(pdf)
  • Tuition Remission Plan Guide(pdf)
  • Tuition Remission Tax Exclusion Form(pdf)
  • Tuition Remission Taxation Guidelines(pdf)
• Insurance Forms
  • Prudential Statement of Health Form(pdf)
• Relocation & Moving Services Program
  • Welcome Letter
  • Internal Guidelines
  • Authorization Form

Payroll Services Forms

• Address/Name Change(pdf)
  We recommend that employees use Employee Self Service to change their address. For any name changes, please continue to use this form.
• Employee Background Summary(pdf)
• Direct Deposit Form(pdf) We recommend that employees use Employee Self Service to make changes to their Direct Deposit Information.
• W-2 Reorder Form(Word)
• Federal Form W-4: Employee’s Withholding Allowance Certificate(pdf)
  We recommend that employees use Employee Self Service to change their W-4 Federal Withholding.
• Form M-4: Massachusetts Employee’s Withholding Allowance Certificate(pdf)
  We recommend that employees use Employee Self Service to change their M-4 Massachusetts Withholding.
• Attendance Record: 2008-2009(Excel)
• Attendance Record: 2009-2010(Excel)
• Attendance Record: 2010-2011 (Excel)
• Attendance Record: 2011-2012 (Excel)
• Attendance Record: 2012-2013 (Excel)
• Moving Expense Reimbursement Form
  (Excel)

Forms for Managers & Department Admins.

New Hire Processing Forms

• Staff or Faculty New Hire PAF- Use this form when paper new hire forms will be completed(Word)
• Staff or Faculty New Hire PAF – Use this form when employee will complete information online (Word)
• Employee Background Summary(pdf)
• Direct Deposit Form(pdf)
• Federal Form W-4: Employee’s Withholding Allowance Certificate(pdf)
• Form M-4: Massachusetts Employee’s Withholding Allowance Certificate(pdf)
• *NEW* Foreign National Data Form(pdf)
• Form I-9: Employment Eligibility Verification(pdf)
• I-9 Handbook for Employers(pdf)
• Affirmative Action Report (Staff Hires Only)(Word)
• Affirmative Action Report Definition (Word)

Job Description Forms

• Job Description – Open Position – Use this form to replace an incumbent or create a new vacant position(Word)
• Job Description – Compensation Review – Use this form to request review of an existing position(Word)
• Request Form for Compensation Review without a job description – Use this form to request a compensation review when the job description is current(Word)

Personnel Action Forms (PAFs) & other payroll forms

• Staff or Faculty New Hire PAF – Use this form when paper new hire forms will be completed(Word)
• Staff or Faculty New Hire PAF – Use this form when employee will complete information online (Word)
• Change(Word)
• Supplemental Pay(Word)
• Separation(Word)
• Separation Checklist(pdf)
• Summer Leave Action Word)
• Weekly Timesheet – not for New Hires(Word)
• New Hire Timesheet(Word)
• ePAF Student Worksheet(Word)
• ePAF Temporary Employee Worksheet(pdf)
• PeopleSoft HRMS Account Application(pdf)

Performance Development Program Resources

• @Work Guidebook(pdf)
• @Work Guidebook FAQ(pdf)
• Performance Plan Form & Instructions(Word)
• Performance Review Form(Word)
• Performance Review Preparation Checklist
• Employee Performance Summary(Word)
• Feedback Planner (Word)
• Customer Input Suggestions(Word)
• Postdoctoral Scholar Review Form(Word)

Mentoring Program

• Mentoring Program Application(pdf)
• Mentoring Program Partnership Plan & Agreement(pdf)
• Other HR Publications (Employee Handbooks, Periscope, Tipsheets, etc)