Forms/Exhibits Index

Forms may be accessed from this index. You may sort the table by Index, Title, Owner, Published, or Format by clicking on the table headings. Content displayed may be refined by using the column filters located underneath the column titles.

Listings of Retired Forms and Exhibits maybe be found in the disposition table.

Index Title
1-23 Employee Change of Address
3-3 Personnel Action Form
3-5 Record of FLSA (Overtime) Compensation Time Earned and Taken
3-7 Form I-9, Employment Eligibility Verification
3-8 Notice of Voluntary Service
3-9 Criminal Background Check
3-15 Appeal of Disciplinary Action - First Step
3-15A Disciplinary Action Appeal - Continuation
3-16 Employee Clearance
3-18 Sick Leave Pool Application
3-19 Conflict of interest, Conflict of Commitment and Outside Activities
3-23 Request for Family and Medical Leave
3-24 Return to Work Release
3-26 High School Student - Position Information and Application
3-27A New Employee Packet
3-27B Instructions for Completing New Employment Paper Work
3-28 Employee Insurance Enrollment Application
3-30 Benefits Cost Worksheet
3-33 Coverage for Incapacitated Child Form
3-34 Medco Pharmacy Home Delivery Order Form (UT Select)
3-35 Medco Prescription Drug Claim Form (UT Select)
3-36 Transitional Benefits Form
3-37 UT Select Dental Claim Form
3-38 Superior Vision Provider Nomination
3-39 UT FLEX Claim Form
3-40 UT FLEX Direct Deposit Form
3-41 UT FLEX Letter of Medical Necessity
3-42 Fort Dearborn Term Life Beneficiary Designation
3-44 Notice of Creditable Coverage for Medicare Part D
3-45 TRS Form 6 (Notice of Final Deposit and Request for Refund)
3-46 TRS Form 18 (Request for Estimate of Retirement Benefits)
3-47 Transfer Verification Form
3-48 TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program)
3-50 Authorization for Reduction for Employee Contributions
3-51 Authorization for Reduction for Employee Contributions for Employees returning to ORP
3-52 ORP Acknowledgement Form
3-53 Optional Retirement Program (ORP) Retirement Certification Form
3-54 Tax-Sheltered Annuity Disclosure
3-55 Purchase Change Agreement
3-56 Special Catch-Up Provision Disclosure
3-57 Short Term Disability Highlights
3-58 Long Term Care Brochure
3-59 Continuation Coverage Notice
3-60 HIPAA Privacy Information
3-61 Accidental Death and Dismemberment Benefits Guide
3-62 DeltaCare Benefits Guide
3-63 UT System Group Benefit Handbook for Employees
3-64 Group Term Life Benefits Guide
3-66 Long Term Disability Benefits Guide
3-67 Short Term Disability Benefits Guide
3-68 Superior Vision Benefits Guide
3-69 Teachers Retirement System (TRS) Handbook
3-70 UT FLEX Benefits Guide
3-71 UT Select Benefits Guide
3-72 UT Select Dental Benefits Guide
3-73 UT System Group Benefits Handbook for Retirees
3-74 UT System Retirement Programs Guide
3-75 Exit Interview Questionnaire
3-76 Quest Release Time Form
3-78 Classified Staff Evaluation Form - Narrative Format
3-79 Employee Self-Evaluation Form
3-80 Administrative and Professional Form
3-81 Classified Staff Evaluation Form - Check Box Format
3-82 Performance Management Forms
3-83 Performance Management Form for New Employees
3-84 Sample Reference Check Form
3-85 On-Campus Summer Camp / Conference Employment Application
3-86 Flexible Work Arrangement Agreement
3-87 Telecommuting Agreement
3-201 Personal Information Form
3-202 State Employment Verification Form
3-203 Selective Service Registration Verification Form
3-204 Sick Leave Pool Contribution Form
3-205 Financial Disclosure and Conflicts of Interest
3-206 Outstanding Maverick Award Nomination Form
3-207 Hiring Request Questions to Submit to Hiring Review Committee