H.R. Forms

Evidence of Insurability

Evidence of Insurability Form for UNUM Life.

Prudential Retirement Savings Enrollment Form

Prudential Enrollment Form 403(b). NOTE: Original MUST be returned to HR Office/Benefits Manager. • Once you see the deduction on your payroll, you can change your contribution by going to Self Service / Benefits / Benefits Summary / Scroll down to Retirement Savings and click / Click Edit on the next screen and change your election / You can do a flat dollar amount or a percent. You cannot stop your deduction here; that requires a paper form.




Payroll Deduction Form (for medical services)

Authorization to deduct a specified amount from your paycheck for medical services provided.

Job Injury Form

In the event on an on-the-job injury, fill out this form and report incident to the supervisor/department head within 24 hours of the incident, or knowledge of exposure. In the absence of the immediate supervisor or department head, the employee should report the injury to the Administrative Representative on duty.