Human Resources Forms

These documents should not be modified without consent from Human Resources

Frequently Used Forms

Direct Deposit

Dual Employment Request Form (CT-HR25)

Name/Address/Phone Change Form

W-4 CT State Tax & Federal Tax Forms

Work History Form

Tuition Waivers

Tuition Waiver Form for Unclassified Employees (AAUP, SUOAF, Management/Confidential)

Graduate-Level Educational Assistance Tax Reporting Requirements 

 Tuition Reimbursement - Classified Employees Only

• Tuition Reimbursement Application (CO-101) 
• Tuition Reimbursement Instructions

 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 Mary Cavanaugh, University Human Resources Administrator, (860) 832-1856.

Employment Forms

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

• Duties Questionnaire
  

Faculty Forms

• AAUP Emergency Appointment

Part-Time Faculty Hiring Forms

• Part-Time/ Full-Time Faculty Appointment Form

University Assistant Appointment Forms

• University Assistant Appointment Form (2022-23) Effective 7/1/2022

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

Tier 3 and Hybrid Credit Purchase (CO-991)

Voluntary Schedule Reduction Program

• Voluntary Schedule Reduction Request Form

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