Forms

EMPLOYMENT

• Accommodation Request Form
• Accommodation Request Medical Statement
• Direct Deposit Agreement
  
• I-9
• Leave of Absence Application
• Leave of Absence Medical Certification - Employee
• Leave of Absence Medical Certification - Family Member
  
• Name & Address Change Form
• Outside Employment Request Form
  
• Supervisor Checklist
  
• W-4
• M-4
• Workers Status Determination Form
  

Time sheets

For spreadsheets that you would like to edit, you must first save the document to your computer; Right click on the link and choose the Save Target As or Save Link As option.

• Non-exempt time sheet for departments without shift differential
  • Instructions to fill out Non-exempt time sheet for departments without shift differential
    
• Non-exempt time sheet for departments with shift differential
  • Instructions to fill out Non-exempt time sheet for departments with shift differential
• Time and Absence Report - Exempt Employee
  
• Weekly Temporary Time Sheets
  

BENEFITS

• Benefits Enrollment Form
• Tax Dependent Affidavit
  

Flexible Spending Accounts

• Crosby Medical Flex Account Claim Form
• Crosby Dependent Care Claim Form
• Crosby Direct Deposit Form
  

Health

• Harvard Pilgrim Fitness Reimbursement Form
• Harvard Pilgrim POS Claim Form
• Mail-order Prescription Form
• HIRD Form - Eligible for Group Plan
• HIRD Form - Not Eligible for Group Plan
  

Life Insurance

• Beneficiary Designation Form (English)
• Designacion de Beneficiarios (Spanish)
  

Retirement

• 403(b) Salary Reduction Agreement
• Verification of Service Credit Form
  

Tuition

• Tuition Waiver Form (available in Office of HR/AA)