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Rose-Hulman Human Resources
 

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RHIT Forms Index


AFFILIATE DATA RECORD FORM

COMPUTER USE FORM

CONFLICT OF INTEREST DISCLOSURE FORM

CURRENT EMPLOYEE/PAYROLL CHANGE FORM

TEMPORARY EMPLOYEE/PAYROLL FORM

DIRECT DEPOSIT OF FLEXIBLE SPENDING ACCOUNT AGREEMENT 

DIRECT DEPOSIT FOR PAYROLL FOR FACULTY AND STAFF

EMPLOYEE COURSE FOR CREDIT POLICY & APPLICATION

FACULTY AND STAFF PAYROLL DEDUCTION/RECURRING GIFT FORM

FLEXIBLE SPENDING DEPENDENT CARE REIMBURSEMENT CLAIM FORM

FLEXIBLE SPENDING HEALTH CARE REIMBURSEMENT CLAIM FORM

FULL-TIME VISITING FACULTY POSITION AUTHORIZATION

HEALTH ENROLLMENT CHANGE FORM

REASONABLE ACCOMMODATION REQUEST FORM

RESEARCH ASSOCIATE POSITION AUTHORIZATION

RETURNING VISITING FACULTY POSITION AUTHORIZATION

SALARY REDUCTION AGREEMENT

SUPPLEMENTAL PAY AUTHORIZATION FORM FOR FACULTY

EMPLOYEE COURSE FOR CREDIT APPLICATION

TUITION PROGRAMS (DEPENDENT)

PART-TIME VISITING FACULTY POSITION AUTHORIZATION

PERFORMANCE APPRAISAL FORMS

PRIZES, AWARDS, GIFTS AND SCHOLARSHIP NOTIFICATION FORM


RHIT Forms

CURRENT EMPLOYEE/PAYROLL CHANGE FORM
(To ensure proper use of this form, it is recommended that you save the form to your desktop.  This can be done by clicking on the MS Word icon in the upper left hand corner, give the file a new name and click the SAVE button.  This will ensure that edits made to the form will be saved.  It is a good practice to save your work every five minutes).

This Current Employee/Payroll Change form is to be initiated by the hiring supervisor to provide all necessary payroll change information for current employees (i.e.: department transfer, salary adjustment, title change, status change).

PROCEDURE:

*      Return completed Current Employee/Payroll Change form to Human Resources for processing.

*     After the Current Employee/Payroll Change form has been processed, Human Resources will generate a revised employment letter for the employee and process all approved changes.

       Current Employee/Payroll Change Form (PDF format)
        (Revised May 2013)

       Temporary Employee/Payroll Form (PDF format)
        (Created June 2013)


DEPENDENT CARE ACCOUNT CLAIM FORM
This form serves as a claim form for reimbursement from the Section 125 Dependent Care Account.  The form is submitted to UMR, along with receipts for eligible services.  UMR will send a reimbursement  directly to your checking or savings account on file with UMR. 

        Flexible Spending Dependent Care Reimbursement Claim Form                 

FLEXIBLE SPENDING ACCOUNT CLAIM FORM
This form serves as a claim form for reimbursement from the Section 125 Flexible Spending Account.  The form is submitted to UMR, along with receipts for eligible services.  UMR will send a reimbursement  directly to your checking or savings account on file with UMR. 

        Flexible Spending Health Care Reimbursement Claim Form                 


HEALTH ENROLLMENT CHANGE FORM

        Health Enrollment Change Form (PDF format)       


REASONABLE ACCOMMODATION REQUEST FORM
Individuals who are employed at Rose-Hulman Institute of Technology and are requesting reasonable accommodation(s) under the Americans with Disabilities Act of 1990 (ADA) and the Americans with Disabilities Act Amendments Act of 2008 (ADAAA) are to complete this form and submit to Human Resources. If you need assistance completing this form, please contact Human Resources.

        Reasonable Accommodation Request Form (PDF format)       


The SALARY REDUCTION AGREEMENT is to be completed to make tax deferred contributions to the Retirement Plan.

       Salary Reduction Agreement (PDF format)   


The SUPPLEMENTAL PAY AUTHORIZATION FORM is to be completed for faculty with additional pay.
       Supplemental Pay Authorization for Faculty
(PDF format)   

 

The EMPLOYEE COURSE FOR CREDIT APPLICATION is to be completed by employees for any college course that relates to their current position. 

 

     Employee Course for Credit Policy (PDF Format)

     Employee Course for Credit Application (PDF format)     


 

The TUITION EXCHANGE APPLICATION is to be completed by eligible full-time faculty and staff members and part-time benefits eligible staff members who have dependent children.  Before downloading an application, please click here to read the guidelines for this program.

 

       Tuition Exchange Application (PDF format)     

 

The DEPENDENT TUITION APPLICATION is to be compelted by eligible full-time faculty and staff members and part-time benefits eligible staff members who have dependent children. Before downloading an application, please click here to read the guidelines for this program.

 

      Dependent Tuition Application (PDF format)     

 


PERFORMANCE APPRAISAL FORMS
(To ensure proper use of this form, it is recommended that you save the form to your desktop prior to editing the form.  This will ensure that edits made to the form will be saved.  It is a good practice to save your work every five minutes). If you receive a message that indicates that you cannot save this document, please check the box that says 'Do not show me this message again' and click 'ok.' Then click 'Save As' and save to your desktop for editing.

The Performance Appraisal form is to be completed by the supervisor using the job description as a guide.

    Please read above paragraph before completing the forms below!

 

         Exempt and Non-Exempt Employee Performance Appraisal (PDF Format)

         Exempt and Non-Exempt Employee Performance Appraisal (Word Format)

 

         (Please use Hourly Employee Performance Appraisal for Auxiliary Enterprises, Facilities, and Public Safety only.)

         Hourly Employee Performance Appraisal (PDF Format)

         Hourly Employee Performance Appraisal (Word Format)

 


The Employee Self-Appraisal is to be completed by the employee prior to the performance appraisal discussion.

    Please read above paragraph before completing the forms below!

 

         Exempt and Non-Exempt Employee Self-Appraisal (PDF Format)

 

         Hourly Employee Self-Appraisal (PDF Format)

         Hourly Employee Self-Appraisal (Word Format)

 


The Performance Improvement Plan is to be completed for each general factor that is rated as "Needs Improvement".  It is NOT corrective action!  It is used to identify performance issues, communicate expectations and define what improvements need to be made by establishing measurable goals for attaining improvements.  It identifies how the employee will accomplish these goals and how the supervisor will help support the employee to meet these goals.

         Performance Improvement Plan (PDF format)
                 (Revised December 2003)        


The Job Analysis Questionnaire is to be completed to assist Human Resources in developing a job description.

         Job Analysis Questionnaire (PDF format)
                 (Revised January 2004)        


Prize, Awards, Gifts and Scholarship Policy

The Internal Revenue Code states that under certain circumstances the value of prizes and awards/gifts to individuals is considered taxable income. Non-US citizens may be subject to additional tax rules, depending on circumstances and treaty status.   Historically, the terms “prize” and "award" have been used by departments for payments distributed to students during the academic year, most notably on Honors and Awards Day. Unless the student entered and won a judged competition, such payments are Scholarships, not Prizes.

The Prize, Awards, Gifts and Scholarship Notification Form is to be completed to instead of a check request for all departmental prizes, awards, gifts or scholarships and forwarded to Human Resources.                   

   Prize, Awards, Gifts and Scholarship Policy         

   Prizes, Awards, Gifts and Scholarship Notification Form  (PDF format)


 

If you have any questions regarding the use of these forms,

please contact Human Resources at ext. 8176.

Last updated October 22, 2013 PMP

 
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