RHIT Forms Index
COMPUTER USE FORM
CONFLICT OF INTEREST DISCLOSURE FORM
CURRENT EMPLOYEE/PAYROLL CHANGE FORM
DIRECT
DEPOSIT OF FLEXIBLE SPENDING ACCOUNT AGREEMENT
DIRECT DEPOSIT FOR PAYROLL FOR FACULTY AND STAFF
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
(new form 9/20/02):
(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 November 2011)
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 HealthSmart, along with receipts for
eligible services. HealthSmart will send a reimbursement
directly to you.
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 HealthSmart, along with receipts
for eligible services. HealthSmart will send a reimbursement
directly to you.
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
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.
Performance
Appraisal
(Please read above paragraph)
(PDF format) to type
electronically
Performance Appraisal
(Word Format)
(Revised December 2003)
The Employee Self-Appraisal
is to be completed by the employee prior to
the performance appraisal discussion.
Employee Self-Appraisal Appraisal
(PDF format)
to type electronically
(Revised December 2003)
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
April 18, 2012
PMP
