Forms

All current HR forms are located on this page. Please note that many functions may be completed without completing a hard copy form through HR Connection. Click on a link below to jump to the forms associated with that category.

Benefits Enrollment
Insurance Benefits
Work/Life Benefits
Prospective Employees
Employment/Hiring
Manager Resources
Equal Opportunity Services
New Employees

Category	Forms
Benefits Enrollment Note: benefits changes can be performed online through HR Connection.	Benefits Change Form for Part-Time or Full-Time Employees - use HR Connection Benefits Enrollment/Change Form for Local 95 Employees (.pdf) Benefits Enrollment/Change Form for COBRA Participants (.pdf) Benefits Enrollment/Change Form for Retired Carnegie Mellon Employees (.pdf) 2008 Domestic Partner Registration Packet for Full-Time Carnegie Mellon Faculty and Staff (.pdf) 2008 Domestic Partner Registration Packet for Part-Time Carnegie Mellon Faculty and Staff (.pdf)
Insurance Benefits	Health Insurance (Note: See the carrier website for most Health Insurance forms.) UPMC HRA Claim Form (.pdf) HealthAmerica FlexChoice HRA Claim Form (.pdf) - CBSA Highmark Medical Claim Form (.pdf) Highmark HRA Claim Form (.pdf) - EBDS Blue Cross/Blue Shield Major Medical Claim Form (.pdf) Prescription Drugs Caremark/PharmaCare Mail Order Service Patient Profile Enrollment Form (.pdf) Caremark/PharmaCare Direct Member Reimbursement Form (.pdf) Caremark/PharmaCare Prior Authorization Request Form (.pdf) Merck-Medco Health, Allergy & Medication Questionnaire (.pdf) Dental Standard Claim Form (.pdf) Vision Davis Vision Direct Reimbursement Claim Form (.pdf) Health Care Flexible Spending Accounts EBDS HCFSA Claim Form (.pdf) HealthAmerica FlexChoice HCFSA Claim Form (.pdf) Life Insurance and AD&D Minnesota Life Beneficiary Designation - Use HR Connection. MetLife Statement of Health Form (.pdf) Dependent Care Reimbursement Accounts EBDS DCRA Claim Form (.pdf) International Benefits Benefits Enrollment/Change Form for International Employees (.pdf) CIGNA Enrollment/Change Form (.pdf) CIGNA Claim Form (.pdf)
Work/Life Benefits	Tuition Benefits Application for Staff Tuition Benefits (.pdf) Application for Tuition Benefits for Children (.pdf) Non-Degree Student Registration form (.pdf) Request for Student Verification (.pdf) Retirement Accounts (Information about investment fund options available through TIAA-CREF and Vanguard) New Supplemental Retirement Account - Salary Reduction Agreement (.pdf) TIAA-CREF Faculty and Staff Retirement Account (GRA) enrollment application (.pdf) TIAA-CREF Supplemental Retirement Account (GSRA) enrollment application (.pdf) Vanguard Enrollment & Change Form (.pdf) Prior Retirement Plan Participation form (.pdf) - to fill out if you already have a retirement plan Retirement Plan Change form (.pdf) TIAA-CREF Forms Download Center Vanguard Asset Transfer form (.pdf) Child Care 2008-09 Cyert Center Benefits Instruction Letter for Grandfathered Families 2008-09 Cyert Center Benefits Instruction Letter for Families Enrolling in 2004 to Present 2008-09 Cyert Center Benefit Application Get Well Room: Fact Sheet, Health Assessment Form and Registration Form (.pdf) FMLA and Leaves of Absence Application for Family and Medical Leave of Absence form (.pdf) Medical Certification form (.pdf) - for leaves related to your medical condition Physicians Certification form (.pdf) - when caring for a family member Return To Work Certification Form (.pdf) Worker's Compensation Workers' Comp Supervisor's Injury/Illness Report (.pdf) Workers' Comp Acknowledgement of Rights & Duties (.pdf) Return To Work Certification Form (.pdf) ID Cards Request for ID Cards for Family Members (.pdf) - must have family member as a declared dependent or registered domestic partner.
Prospective Employees	Careers@CarnegieMellon - to apply for positions
Employment/Hiring	Faculty Affirmative Action Form (.xls) Government Contractor Notice (.doc) - to self identify as disabled, a disabled veteran, or a Vietnam veteran. Position Description Guidelines (.pdf) - enter or update PDs through TMS. Staff Diversity Recruiting Action Plan (.doc) Temporary Employment Service Temp Request Form Wage Determination Packet (.doc) - for H1B visa status hires
Manager Resources	Equipment Loan Statement of Understanding (.pdf) Intellectual Property Policy Agreement form (see also: Policy) Performance Improvement Plan (.doc) Performance Review Form (.doc) [see also PR Guidelines (.pdf)] Personnel Record Checklist Provisional Period Performance Review Form (.doc) PTO Tracking Worksheet (.xls) Statement of Understanding of the Family Educational Rights and Privacy Act (FERPA) (.pdf) Workers' Comp Supervisor's Injury/Illness Report (.pdf) Workers' Comp Acknowledgement of Rights & Duties (.pdf)
Equal Opportunity Services	Employee Self-Identification form (.pdf) Student Disclosure of Disability form (.pdf) Verification of a Disability (.pdf) - for sending proof of a disability to Carnegie Mellon Verification of a Disability/Parking (.pdf) - to request special parking services Verification of a Temporary Disability (.pdf) Permission to Share Information form (.pdf) - to allow Carnegie Mellon to share selected information regarding disability or accommodations with individuals outside the university Release of Information form (.pdf) - for releasing disability test results to Carnegie Mellon Alternative Format Request form (.pdf) - to request services such as books on tape, enlarged materials, readers, Braille, etc. Equipment/Software Loan Request form (.pdf) Intake/Accommodations form (.pdf) - to request specific accommodations from Human Resources Interpreter Request form (.pdf) Interpreting Service Evaluation (.pdf) Request for Proctored Exam (.pdf) Government Contractor Notice (.doc) - to self identify as disabled, a disabled veteran, or a Vietnam veteran.
New Employees	Benefits Enrollment Forms Insurance Benefits Forms Work-Life Benefits Forms Intellectual Property Policy Agreement form (see also: Policy) Government Contractor Notice (.doc) - to self identify as disabled, a disabled veteran, or a Vietnam veteran. PTO Tracking Worksheet (.xls) Statement of Understanding of the Family Educational Rights and Privacy Act (FERPA) (.pdf)