These documents should not be modified without consent from Human Resources
Frequently Used Forms
Dual Employment Request Form (CT-HR25)
Name/Address/Phone Change Form
W-4 CT State Tax & Federal Tax Forms
Tuition Waivers
Tuition Waiver Form for Unclassified Employees (AAUP, SUOAF, Management/Confidential)
Graduate-Level Educational Assistance Tax Reporting Requirements
Tuition Reimbursement - Classified Employees Only
Scholarships
- Classified Employee and/or Dependent Child Announcement Letter
- Classified Employee and/or Dependent Child Scholarship Award Guidelines
- Classified Employee Scholarship Application
- Classified Employee Dependent Child Application
For additional information on the Classified Scholarship Program, please contact humanresources-1@mail.ccsu.edu
Employment Forms
Situational Telework
Administrative Faculty Telework
Background Check and Authorization
- Disclosure and Consent Form
- Social Security Verification Authorization (SSA-89)
- Summary of Your Rights Under Fair Credit Reporting Act (FCRA)
Classification
Faculty Forms
Part-Time Faculty Hiring Forms
University Assistant Appointment Forms
- University Assistant Appointment form (2024-25) Effective 4/27/2023
- University Assistant Appointment form (2025-26)
Search Forms
- AAP-1 Personnel Action Request Form
- AAP-2 Affirmative Action Search Plan
- AAP-3 Authorization to Interview
- AAP-4 Recommended Candidates
- C-1 Classified Authorization to Interview
- C-2 Classified Recommended Candidates
- Temporary Appointment Form (SUOAF and Management Confidential)
Faculty Related Forms
- 10.12 - Instructional Faculty Authorization Form
- 10.12.1 - Duties with No Load Credit
- 10.13 – External Teaching Employment Form
- Dual Employment Form (CT-HR-25)
- Compliance Form for Full time Faculty for Reporting of Research or Consulting with Outside Public or Private Entity
- Faculty Consulting and Research with Private and Public Entities FAQ’s
- Procedure for Reporting of Research or Consulting with Outside Public or Private Entity
- Employee Information Sheet
Evaluation Forms
AAUP Evaluation Forms
- Teaching Faculty Evaluation & Recommendation for Renewal, Tenure & Promotion or Professional Assessment
- Coach and Non-Instructional Athletic Trainer Evaluation & Recommendation for Renewal & Promotion
- Counselor Evaluation & Recommendation for Renewal, Tenure, Promotion or Professional Assessment
- Librarian Evaluation & Recommendation for Renewal, Tenure, Promotion or Professional Assessment
Classified Employee Evaluations Forms
- Administrative Clerical
- Administrative & Residual
- Maintenance & Service
- Protective Services
- SUOAF Evaluation Form
Medical Related Forms
- Employee Request Form (FMLA-HR1)
- Employee Medical Certificate – (P33A)
- Caregiver Medical Certificate – (P33B)
- Health Enhancement Program Plan Enrollment Form - (CO-1314)
- Intent to Return to Work – (FMLA-HR3)
- Military Family Leave – Employee – Attachment
- Military Family Leave – Service Member
- Sick Leave Bank Grant Application – AAUP – Attachment
- Sick Leave Bank Grant Application – Management/Confidential - Attachment
- Sick Leave Bank Grant Application - SUOAF
For additional FMLA information contact Victoria Karwowski in Human Resources, at (860) 832-1759.
Retirement Forms
- Limited Durable Power of Attorney Pre Retirement Form (CO-1049)
- Designation of Retirement Plan Election (CO-931h)
- Designation of Retirement Plan Beneficiary (CO-999)
- Retirement Credit Purchase Request for Prior Miscellaneous Services Form
- SERS Tier IV Summary
Tier 3 and Hybrid Credit Purchase (CO-991)
Voluntary Schedule Reduction Program
Workers’ Compensation
- DAS Form 207 - First Report of Injury
- DAS Form 207-1 - Incident Review Report
- WCC Form 1A - Filing Status and Exemption
- DAS Form PER-WC 211 - Concurrent Employment and Third-Party Liability
- DAS Form WC-715 - Request for Use of Accrued Leave With Workers' Compensation
- DAS Form 208 – Worker Status Report