These forms are available in Adobe Acrobat (.pdf) format and allow you to do one of two things.
- You may print off the form, handwrite the necessary information and turn it in to Human Resource Services.
- You may type directly on the form (by clicking your mouse on the blank lines), then print it off and turn it in to Human Resource Services.
The forms will all open in a new window.
- Address, Change of - link for 6-digit PSD codes and appropriate earned income tax rates
- Cell and Smart Phone Stipend Approval Form
- Certificate of Residency - link for 6-digit PSD codes and appropriate earned income tax rates
- Confidential Information Sheet
- Emeriti Claim Form - for retirees
- Flexible Spending Forms - for health and dependent care reimbursements
- Home Buyer Application - to apply for a loan through the Home Buyer Program
- I9
- Insurance Enrollment/Change Form - for adding/removing dependent(s) and enrolling in coverage(s)
- Life Insurance Beneficiary Designation Form
- Life Status Change Form
- Local Services Tax Form
- Local Services Tax Exemption Certificate - must be completed by an employee before we are permitted to make this $52 tax exempt. Required documentation must also be included.
- Local Services Tax Refund - If this tax is withheld and later determined that it shouldn't have been, a refund must be requested through the Capital Tax Collection Bureau.
- Pay Advance Request Form
- Position Description Questionnaire Form
- Relocation/Moving Expense Reimbursement Form - for eligible employeees
- Retirement
- Employer Contribution Designation Form 2023 - employees eligible for this benefit may choose to have their contribution sent to either TIAA and/or Fidelity
- Employer Contribution Designation Form 2024 - employees eligible for this benefit may choose to have their contribution sent to either TIAA and/or Fidelity
- Retirement - Emeriti Voluntary Contribution Form - employees may invest after tax money with TIAA for a VEBA to be used for health care during their retirement.
- Retirement
- Tax Deferred Annuity Election Form for calendar year 2023 - to change your retirement contribution amount
- Tax Deferred Annuity Election Form for calendar year 2024 - to change your retirement contribution amount
- Sick Leave Bank Donation Form - Non-exempt staff may complete this online fillable form to submit donated vacation day(s) to Human Resource Services to participate in the Sick Leave Bank. (Please note: Your network username and password may be required to access and sumbit this online form.)
- Tuition Assistance Form - to apply for assistance for your child to attend an institution other than Dickinson
- Tuition Exchange Form - to apply to a tuition exchange school
- Tuition Remission Form - to apply for remission for tuition at Dickinson
- W4
- Workers Compensation - Reporting your injury along with an Incident Report Form is required. Treatment Authorization Forms for either Concentra or AllBetterCare should also be completed prior to seeking treatment for an injury at work. Additionally, the Workers Compensation reporting form can be completed in the Gateway.
Search Committee members may find interview evaluation forms within Quest once added to a search committee, or via the Totara training course for Search Committee members.