Forms

Most of the forms on this page are PDFs. Many of them can be completed and submitted electronically. To do so download the PDF to your computer and open in Adobe Reader (available for free).

Beneficiaries

Insurance Plans

Add or change beneficiaries for the IU insurance plans

Retirement Plans

To change the beneficiaries on your IU retirement plan account(s) contact the company directly.

Fidelity Investments
TIAA
PERF

Health Savings Account (HSA)

Change the beneficiaries on your HSA at Nyhart IU Online Services.

Employment

Authorization Form for Motor Vehicle Records Check (Office of Insurance, Loss Control & Claims)

Use the eLink option for all background checks. If exceptional circumstances require manual entry, the following form must be reviewed and signed beforehand.
Background Check Consent Statement

Conflict of Interest Disclosure Statement

Employee Referral Incentive Validation Form

Employee Request/Written Authorization for Release of Personnel Files

Essential and Marginal Job Functions Worksheet (Word doc)

I-9 Form and Instructions

Reasonable Accommodation Request and Documentation Form

Request for Seasonal Employment of Temporary Employee (requires IU logon)

Staff Position Posting Request (web form, goes to PeopleAdmin staff side)

Bloomington:
Telephone Reference Check

Temporary Positions Employment Applications

Application

Use the eLink option for all background checks. If exceptional circumstances require manual entry, the following form must be reviewed and signed beforehand.
Background Check Consent Statement

Work History Supplement

Grievance & Staff Reports

Grievance

Professional and Non-union Support and Service Staff

Temporary Employees

Bloomington and Northwest
Support Staff

Bloomington, IUPUI, and South Bend:
Service Employees

Bloomington, East, IUPUI, Kokomo, Northwest, South Bend, and Southeast
Police Service Employees

Staff Report

Bloomington:
Staff Report (Word doc, for long documents)
Staff Report (PDF, for short documents)

Health (Medical, Dental, and Prescription)
Insurance

Basic Life Insurance

Add or change beneficiaries online at the Employee Center (select Benefits) or download and complete the PDF.

Long-term Disability Insurance

Claim Packet

LTD enrollment/change/terminate form (PDF)

Medical History Statement

Personal Accident Insurance (PAI)

Add or change beneficiaries online at the Employee Center (select Benefits) or download and complete the PDF.

Accidental Dismemberment: Proof of Loss Claim Form (PDF)

Accidental Death: Proof of Loss Claim Form (PDF)

Supplemental Life Insurance

Add or change beneficiaries online at the Employee Center (select Benefits) or download and complete the PDF.

Enrollment Form

Medical History Statement

Personal Information and Life Events changes

Life Events changes (select Benefits)

Personal Profile Forms

Change Form, Personal Data
Update personal information already on file (legal name, marital status, SSN, etc.)

Personal Profile Form (ED)
Must be completed by the newly hired employee

Personal Profile Form (PS)
For the employee to identify prior work experience, professional education, licenses etc.

Retirement Plans

PERF

See the INPRS web site for PERF forms

Salary Deferral Agreements

IU Retirement Savings Plan 457(b)

IU Tax Deferred Account (TDA)

Beneficiaries

To add or change beneficiaries contact the company(ies) directly:
Fidelity Investments
TIAA
PERF

Student Health Insurance

IU Health Center Claim Form

See the Student Health Insurance web pages for forms specific to each plan

Tax Savings (Commuting, HSA, and TSB)
Tuition Benefit and IUHS

Online IU Tuition Benefit Enrollment Form
      Also available as a PDF:
         2019-20 Academic Year
         2018-19 Academic Year

IUHS Tuition Waiver Form

Unsafe Working Conditions

Service positions Bloomington:
Unsafe Working Conditions (Also available as a Word doc)

To complete and submit this form digitally, download it to your computer first.

 

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