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HUMAN RESOURCES

Forms Index

The forms below must be printed out, filled in, and returned to the appropriate office by mail or in person.  Click on the alpha character below to find forms more quickly by name.

[A] [B] [C] [D] [E] [F] [G] [H] [I] [J] [K] [L] [M] [N] [O] [P] [Q] [R] [S] [T] [U] [V] [W] [X] [Y] [Z]

Form by Name Purpose of this Form Versions
AAO-1 Populated University support staff and Unclassified AAO-1 reports for both PeopleAdmin 5 (old) and People Admin 7 (new) are found in the "HR - Hiring Reports" folder through Reporting Services on Banner.  If you are unable to reach the reports, contact Tonya.Cruz@wichita.edu at ext. 3061 to request access.  
Accident or Illness Report Form Report must be sent to Office of Human Resources within 3 days of Workers Comp related incident.

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Advanced Leave Leave Advancement is leave provided to an employee pursuant to Executive Order 09-08 (see Bulletin No. 09-05) and must be requested and approved in accordance with appropriate agency policies and procedures. A committee, chaired by the Director of Human Resources, may choose not to provide this leave to an employee if it is believed an employee has abused their leave privileges.

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Additional Compensation, OHR 210 Compensation for work not related to a full-time unclassified employee's regular duties and not performed during regular work hours (e.g. teaching a class). >>See completion guidelines for OHR 210.

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Address Change All faculty and staff are encouraged to review the information now in their employee records.  In addition, one may review and update her/his ethnicity and race using the new federal guidelines.  The Human Resource Office is also asking everyone to provide emergency contact information.  The Web application is inside the myWSU portal.  To access this tool, please log into the myWSU portal, click on the Faculty/Staff Resources tab, and in the Administrative Tools channel you will find the link "Demographic Verification."  You can then follow the directions provided.  The document linked on the right may still be used to update your address with Human Resources.

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Agency Temp, Clerical Request To hire individuals through a temporary agency as per contract with the State of KS.  >>See clerical pay chart.

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Agency Temp, Industrial Technology Request To hire individuals through a temporary agency as per contract with the State of KS.  >>See industrial technology pay chart.

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Agency Temp, Trades Request To hire individuals through a temporary agency as per contract with the State of KS.  >>See trades pay chart.

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Americans with Disabilities (ADAAA) This form is used for reporting of disability status and request for special accommodations.

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Appointment, OHR 300 To appoint an individual to a position (other than as a Lecturer, Research or Summer Session appointment) at the conclusion of a search or direct hire to a new non-benefits eligible position.  PeopleAdmin is used for all benefits eligible new positions.  >>See guidelines for completing the OHR 300.

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Appointment - Lecturer, OHR 310 To appoint temporary semester appointments that may include lecturers and paid adjunct appointments. Exempt positions paid a salary either incrementally or at semester end. (May be benefits eligible, dependent on credit hours taught in consecutive semesters.)  >>See guideliines for completing the OHR 310.

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Appointment - Research, OHR 320 To appoint University support staff, unclassified professional or faculty to a non-benefits eligible position that is partially or totally grant funded. PeopleAdmin is used for all benefits eligible grant funded positions. >>See guidelines for completing the OHR 320.

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Appointment - Summer Session, OHR 330 Appoint lecturer or other unclassified employee (for other than 12-month)during the summer academic period.  >>See guidelines for completing the OHR 330.

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Background Checks Applicants sign the Authorization and Release for Employment Inquiries and/or Reference Checks.  Background checks are required for each person hired for a faculty, unclassified or University support staff positions at WSU that will continue for a term of longer than 6 months.  >>See Protocols and Best Practices for guidelines and forms required.

Who Pays?  There is a central fund in the Office of Human Resources that will pay for all GU positions through their Business Procurement Card (BPC); RU positions will need to be funded by the hiring unit. OHR will assign the BPC charges for RU positions to the hiring unit.

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Change of Status, OHR 200 To show any change in a current employee's status (e.g. promotion or transfer within the University, retirement, termination, name change, reclassification, FTE, title change, provisional to regular appointment, funding change, etc.) >>See guidelines for OHR 200

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Change of Status - Research, OHR 220 Project Director is to prepare a rough draft and send to Office of Research Administration, Campus Box #7 for completion of the form.  >>See guidelines for OHR 220.

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Claims Against the State >>See more regarding personal injury or property loss guidelines and forms.  
Coaching & Behavior Report, Employee This form to be used by managers to document performance or behavior issues of their employees (formal write-up).  Type in the form and print completed form for signatures.  Contact Matthew Johnston with questions/concerns. Word
Corrective Action - Sample Memo This sample memo is to be used by managers to document performance and/or behavior issues of their employees (formal write-up). Edit this document, print completed form for signatures and send the original signed document to Matthew Johnston, Box 15.  Contact Matthew Johnston with questions/concerns. Word
Direct Payroll Deposit Complete this form and submit with voided check or deposit slip for employee's salary to be deposited directly to their bank. If additional banks are needed to split your payroll deposit, complete the Supplemental Direct Deposit Authorization Form (or pdf).

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Emergency Contact Information The Human Resource Office is asking everyone to provide emergency contact information.   To access your emergency contact list, please log into the myWSU portal, click on the Faculty/Staff Resources tab, and in the Employment Details channel you will find the link "Demographic Verification."  You can then follow the directions provided.  It is critical that employees update their emergency contact list when there are life-changing events such as marriage, divorce, death, etc. and when your contacts experience a change of address or phone number.  This information will not be disclosed to other employees or organizations -- it is for the sole purpose of emergency contact in the event of accident/illness.

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Employee Coaching & Behavior Report This form to be used by managers to document performance and/or behavior issues of their employees (formal write-up).  Type directly into the form, print completed form for signatures, and send the original signed document to Matthew Johnston, Box 15.  Contact Matthew Johnston with questions/concerns. Word
Employee Development, Unclassified Professional Supervisors of Unclassified Professional employees can utilize this form to set goals.  This should be done for any area when the Unclassified Professional employees does not meet expections on an evaluation.  It can be used anytime for professional development.  Contact Human Resources Lana.Anthis@wichita.edu  or call (316) 978-6166; Matthew.Johnston@wichita.edu or call (316) 978-6123; or Frankie.Kirkendoll@wichita.edu or call (316) 978-3540 for assistance. Word
Employee Information -- University Support Staff, Unclassified and/or Faculty The State of Kansas requires this information for all employees to record personal information and emergency contacts. All sections must be completed.  (This form is also a page in the sign-up packet for regular and graduate student employees and lecturers.) Word
Employee Separation Checklist This checklist outlines steps that may be helpful for departments who are involved in separation or transfer of a current employee. Word
Employee Suggestion Form A WSU employee whose suggestion is approved and implemented shall receive a "monetary employee award" and an "employee suggestion bonus" as permitted by law and as outlined in the procedures.  >>See Employee Suggestion Program Procedures.

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Evaluation, Unclassified Professional Unclassified professionals are to be evaluated at least annually and evaluation forms submitted through the appropriate channels to the appropriate vice president by May 1. Use the Employee Development form to set goals.  Contact Human Resources Lana.Anthis@wichita.edu or call (316) 978-6166; Matthew.Johnston@wichita.edu or call (316) 978-6123; or Frankie.Kirkendoll@wichita.edu or call (316) 978-3540 for assistance. If the evaluation is for a UP in Academic Affairs, please go to the Academic Affairs website for the proper form.

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Exception Reporting (faculty included) Departments with faculty members may use this form for individuals to report exceptions to their schedule for timekeeping purposes.

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Exception Reporting (faculty not included) Departments with no faculty members may use this form for individuals to report exceptions to their schedule for timekeeping purposes.

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Exit Checklist -- Employee Separation/Transfer Checklist Department to complete page 1 of the checklist for employees in their department who leave employment with the department for any reason.  Completed form to be sent with employees for scheduled exit interview in the Office of Human Resources. Word
Exit Financial Obligations Report Internal HR Form to determine financial obligations for the exit interview process. Word
Exit Interview Questionnaire Employee will complete an on-line questionnaire in HR as part of their exit interview.  
Exit Status Review Form Internal HR form used in the employee exit process -- resignation, retirement, etc. Word
Flexible Spending  - NueSynergy If you are enrolled in a flexible spending account, claim reimbursement of dependent care and/or unreimbursed medical expenses at: https://www.mywealthcareonline.com/kansasfsa/

 

FLSA Designation Form To comply with the Federal Fair Labor Standards Act (FLSA) and University policy, Human Resources will complete the FLSA Designation Form for all unclassified professional positions. >>See FLSA questions & answers. Word
FMLA Certification of Health Care Provider For the physician to provide information concerning the patient to determine FMLA eligibility.  See the Return to Work Authorization form necessary to return to work after a qualifying event.  >>See the FMLA frequently asked questions.

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FMLA Certification of Qualifying Exigency for Military To be completed by the employee.

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FMLA Certification for Serious Injury or Illness of Covered Service Member To be completed by a Department of Defense health care provider.

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FMLA Request Forms To be eligible for the Family & Medical Leave benefit, employees must have 12 months of University/State service and to have worked 1,250 hours in the immediate previous 12 months.  The two pages of this form are to be completed & signed by the employee.  >>See how to apply.

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FMLA Return to Work Form that the Health Care Provider completes to indicate release to return to work specifying any restrictions. Word
Graduate Hiring: Graduate Assistant (GA, non-teaching) To appoint or change the status of a graduate assistant (GA), the department completes the appropriate Grad Assistant ePAF -- to access the ePAF training documents and instruction guides, log-on to myWSU and click on the Help for Faculty/Staff tab.  See Human Resources Help channel, click on Electronic Personnel Action Form (ePAF).

PDF documents to be printed and completed in the department and sent with the Graduate Assistant to HR. This new set of self-extracting documents has been developed by ITS and is an approved replacement for the previous Excel spreadsheets. If you have one of the previous Excel spreadsheets, please stop using it and delete it from your computer.

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Graduate Hiring: Graduate Teaching Assistant (GTA, teaching)

To appoint or change the status of a graduate teaching assistant (GTA), the department completes the appropriate Grad Teaching Assistant ePAF -- to access the ePAF training documents and instruction guides, log-on to myWSU and click on the Help for Faculty/Staff tab.  See Human Resources Help channel, click on Electronic Personnel Action Form (ePAF).

PDF documents to be printed and completed in the department and sent with the Lecturer or GTA to HR. This new set of self-extracting documents has been developed by ITS and is an approved replacement for the previous Excel spreadsheets. If you have one of the previous Excel spreadsheets, please stop using it and delete it from your computer.

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Grievance, Unclassified Professional

This document to be completed by the Unclassified Professional who wishes to submit a grievance. The form can be completed on your computer and printed off, signed and submitted to the Director of Human Resources or the Executive Director of EEO. >>See Section 6.13 of the WSU Policies & Procedures Manual in regard to grievance procedures.

Note: The Word document will "grow" to accommodate the information as you fill in the yellow shaded portion on your computer. You may check the "highlight text" box at the top right of the Adobe document to clearly see which areas are to be completed; but the fields will not "grow" with your text -- attach additional pages as needed.

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Grievance, University Support Staff This form to be completed by university support staff employee who wishes to file a grievance.  >>See the complete University Support Staff Grievance Procedure handbook. PDF
Hiring Process >>See hiring process for University Support Staff, Unclassified Staff, and Faculty.  
Hourly Lecturer Compensation, OHR 311

To add hourly compensation for an individual in a nonexempt benefits eligible teaching position. 

>>See instructions regarding time and pay for a fulltime non-exempt employee to teach a class concurrently

>>Also see form to be used to record comp time and straight time when a non-exempt employee also works in a lecturer position. 

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I-9/Employment Eligibility Verification All U.S. employers are responsible for completion and retention of Form I-9 for each individual they hire for employment. This includes citizens and noncitizens. >>See more I-9 Points to Note for help with the new form. *PDF
International Student Employment Verification Letter Form letter will need to be completed by the hiring department for the nonimmigrant student to present to the Social Security Administration to receive a social security card to work on campus. (Instructions are included on the form.)

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Investment Agreement -- Mandatory Retirement Plan This form is required in order for salary deferral contributions to be made to the Kansas Board of Regents Mandatory Retirement Plan under Internal Revenue Code Section 403(b) and K.S.A. 74-4925. *PDF
Investment Agreement -- Voluntary Pre-Tax This form is required in order for salary deferral contributions to be made to the Kansas Board of Regents Voluntary Retirement Plan under Internal Revenue Code Section 403(b) and K.S.A. 74-4925b. *PDF
Investment Agreement -- Voluntary Roth After-Tax

This form is required in order for salary deferral contributions to be made to the Kansas Board of Regents Voluntary Retirement Plan under Internal Revenue Code (IRC) Section 403(b) and K.S.A. 74-4925b.  >> See  more regarding the Roth Option Announced Jan. 2011.

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KBOR Immediate Participation Form This form allows eligible unclassified and faculty employees to waive their 1-year waiting period and begin contributing to the KBOR Mandatory Retirement Plan immediately.  Employees must submit this to their past employer(s) and have the form returned to Human Resources within 90 days of their hire date in order to be valid. PDF
K-4 Employees hired after 1/1/08 must use the new Form K-4 for State withholding tax purposes.  Employees hired prior to 1/1/08 who wish to adjust state withholding will be required to complete the K-4 form.  These options may now differ from the Federal withholding elections made on Form W-4.  (Instructions are included.) *PDF
Kansas Mentors Program Employees may use up to 90 minutes of work time per pay period to work with an approved mentoring program. This time must fall within the employee's regular work schedule and shall not be used during or result in overtime for non-exempt employees.  >>See more about the program.

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Leave Advancement Leave Advancement is leave provided to an employee pursuant to Executive Order 09-08 (see Bulletin No. 09-05) and must be requested and approved in accordance with appropriate agency policies and procedures. A committee, chaired by the Director of Human Resources, may choose not to provide this leave to an employee if it is believed an employee has abused their leave privileges.

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Leave and Overtime Request Form Optional department timekeeping form.

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Lecturer Hiring To appoint or change the status of a lecturer, the department completes the appropriate Lecturer ePAF -- to access the ePAF training documents and instruction guides, log-on to myWSU and click on the Help for Faculty/Staff tab.  See Human Resources Help channel, click on Electronic Personnel Action Form (ePAF).

PDF documents to be printed and completed in the department and sent with the Lecturer or GTA to HR. This new set of self-extracting documents has been developed by ITS and is an approved replacement for the previous Excel spreadsheets. If you have one of the previous Excel spreadsheets, please stop using it and delete it from your computer.

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Lecturer Time Reporting Form to be used to record comp time and straight time when a non-exempt employee also works in a lecturer position.  Contact OHR timekeeping for additional instructions. Word
List Order Form To order a list for on-campus mailings of current employees or retirees at their home address, you can refer to the Request for Mailing Lists. Electronic media is the property of Wichita State University and should be used for the primary purpose of benefiting, enhancing and furthering the mission of the University.  >>See more about lists.

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New Hire Report, State of Kansas Required by the State of Kansas to report newly hired, rehired and returning employees.
# All new employees must fill out section 1 and answer the questions.
# Department fills out section 2.

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Non-Reappointment Notice Sample letters that can be modified to fit the needs of a department sending out a notice of non-reappointment to unclassified professional staff.  Contact Frankie.Kirkendoll@wichita.edu, ext. 3540 or Matthew.Johnston@wichita.edu, ext. 6123 if you need assistance.  
Oath/Tax Form (A Notary Public is available in Human Resources)
This form includes the Federal Withholding Form W-4 and the State of Kansas Employee's Oath and is completed in HR by new employees.

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Pay Matrix, USS Pay Matrix for University Support Staff. PDF
Payroll Check - Distribution Schedule Current calendar of payroll distribution dates. PDF
Payroll Deposit Form Complete this form and submit with voided check or deposit slip for employee's salary to be deposited directly to their bank. If additional banks are needed to split your payroll deposit, complete the Supplemental Direct Deposit Authorization Form (or pdf).

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Payroll Schedule Schedule of pay periods, pay dates and due dates for paperwork: Word
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PeopleAdmin Training is required for departments to obtain security to fill vacancies. Training sign-up is available through the myWSU Help for Faculty/Staff tab using the Training/Workshop Registration, Schedule link.  Contact Dale.Catlin@wichita.edu, ext. 6150 to schedule individual or group training.  
Performance Management Process Contact Frankie.Kirkendoll@wichita.edu for training.  Contact Joan.Antes@wichita.edu for log-in/password assistance or improper dates on evaluations. The PMP system allows for a range of October 1 to December 22 for the completion of evaluations.  >>See more.  
Position Description, University Support Staff The University Support Staff Position Description (revised: 10/09/2012) has been formatted to follow the fields in PeopleAdmin. The form is in a Word table format that will "grow" to fit the information you type in. Assistance and direction for writing position descriptions will be provided by Human Resources. Contact Libby.Gilbert@wichita.edu  or call (316) 978-6124. Word
Position Description, Unclassified The Unclassified Position Description (revised: 10/09/2012) has been formatted to follow the fields in PeopleAdmin.  The form is in a Word table format that will "grow" to fit the information you type in.  Assistance and direction for writing position descriptions will be provided by Human Resources.  Contact Lana.Anthis@wichita.edu or call (316) 978-6166 or Libby.Gilbert@wichita.edu or call (316) 978-6124. Word
Positive Time Reporting (in-out) An optional timekeeping form.

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Reclass Request Contact Libby Gilbert prior to completing a request to reclassify a position.  (Instructions included on 1st page.)

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Reclassification: Employee Worksheet A 2-page form that an employee may use to outline the duties & responsibilities of their position when seeking a reclassification.

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Reclassification: Supervisory Analysis of Position A 2-page form that the supervisor can use to analyze a position that might be considered for reclassification.

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Reference Check A form for the search committee to use for prior employment reference checks on applicants who have interviewed for a position.

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Request to Fill, OHR 100 Begins the search process to fill any non-benefits eligible University support staff, unclassified or faculty position.  Benefits eligible searches are done through PeopleAdmin.  >>See guidelines for OHR 100

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Request to Fill - Research, OHR 120 Project Director is to prepare a rough draft for non-benefits eligible positions and send to Office of Research Administration, Campus Box #7 for completion of the form. Benefits eligible research searches are done through PeopleAdmin.  >>See guidelines for OHR 120

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Resignation Form Letter Employee should give supervisor written notice of resignation.

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Return to Work Authorization Form that the Health Care Provider completes to indicate release to return to work specifying any restrictions.

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Rhatigan Student Center HR Forms  
Salary Reduction Authorization For salary deferral contributions to be made to the Kansas Board of Regents Voluntary Retirement Plan. *PDF
Search Waiver This form is found on the Academic Affairs Search Information web page.  
Shared Leave, Confidentiality Waiver Authorization for WSU to obtain necessary information in regard to your request for shared leave.

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Shared Leave, Donation of Time Form for WSU employee to voluntarily donate leave to another employee on shared leave.

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Shared Leave, Request for Time Form for WSU employee to apply for shared leave.  >>See more about shared leave.

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Social Security (for jobs not covered) All student employees hired after 1/1/2005 must complete this form.  >>See more at SSA-1945.

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Spoken English Screening Form (Faculty Only) This form is used exclusively for faculty only and is an assessment tool required by the Kansas Board of Regents.  This form is found on the Academic Affairs Faculty Forms page.  
Spoken English Screening Form (Graduate Students and Lecturers Only) This form is used exclusively for graduate students and lecturers only and is an assessment tool required by the Kansas Board of Regents.  This form is found on the Academic Affairs Faculty Forms page.  
State of KS Employees Oath This form includes the Federal Withholding Form W-4 and the State of Kansas Employee's Oath and is completed in HR by new employees.

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Student Hiring: Regular, Graduate (GA, non-teaching) or Work-Study To appoint or change the status of regular or work-study students, the department completes the appropriate Student ePAF -- to access the ePAF training documents and instruction guides, log-on to myWSU and click on the Help for Faculty/Staff tab.  See Human Resources Help channel, click on Electronic Personnel Action Form (ePAF).

PDF documents to be printed and completed in the department and sent with the student employee to HR. This new set of self-extracting documents has been developed by ITS and is an approved replacement for the previous Excel spreadsheets. If you have one of the previous Excel spreadsheets, please stop using it and delete it from your computer.

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Student Consent for Inspection All student employees required to sign this form to authorize WSU to inspect and/or release form I-9 information to Immigration & Naturalization Service.

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Student Employment Application Departments may use this application format.

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Student Exception Request Request for exception of minimum credit hours requirement for students to work on campus.

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Student Time Reporting Positive in and out time reporting for student employees.

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Substance Abuse Policy (WSU Policy & Procedures 5.04) The following form is required by state law; the department signs as Agency Representative.

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Tax Clearance Information Form Form to acknowledge that candidate or employee has been informed of the Tax Clearance Program for the State of Kansas and that they're aware of the requirements for payment, if applicable. PDF
 Tax Compliance, Glacier Nonresident Alien Withholding Complete the set up form for enrollment in a web based tax compliance system for foreign nationals employed by the University. >>See more.

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Tax Withholding, State K-4 Complete this form to change number of dependents for State income tax withholding from employee's salary.  (Instructions are included on the form.) *PDF
Tax Withholding, Federal W-4 Complete this form to change number of dependents for income tax withholding from employee's salary. *PDF
Temporary Agency Help -- Administrative Requisition form to request temporary agency administrative & office support staff.   >>See pay chart.

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Temporary Agency Help -- Information Technology Requisition form to request temporary agency information technology staff.  >>See pay chart.

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Temporary Agency Help -- Trades & Light Industrial Requisition form to request temporary agency trades & light industrial staff.  >>See pay chart.

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Tuition Assistance, Dependent/Spouse Application The Tuition Assistance Program for Spouses and Dependent Children (WSU Policy 3.43 effective: December 1, 2011) is available to the spouse and/or dependents of all full-time employees at Wichita State University.  >>See additional information and links to the required applications.  
Tuition Assistance, Employee Application The University has authority under state law to pay tuition and other education expenses for the education or training of eligible University employees when such education or training has been determined to be of value to the state and the University.  >>See additional information.

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Unclassified Position Description The Unclassified Position Description (revised: 10/09/2012) has been formatted to follow the fields in PeopleAdmin. The form is in a Word table format that will "grow" to fit the information you type in. Assistance and direction for writing position descriptions will be provided by Human Resources. Contact Lana.Anthis@wichita.edu or call (316) 978-6166 or Libby.Gilbert@wichita.edu or call (316) 978-6124. Word
Unclassified Professional Employee Development Supervisors of Unclassified Professional employees can utilize this form to set goals. This should be done for any area when the Unclassified Professional employee does not meet expections on an evaluation. It can be used anytime for professional development. Contact Human Resources Lana.Anthis@wichita.edu or call (316) 978-6166; Matthew.Johnston@wichita.edu  or call (316) 978-6123; or Frankie.Kirkendoll@wichita.edu or call (316) 978-3540 for assistance. Word
Unclassified Professional Evaluation

Unclassified professionals are to be evaluated at least annually and evaluation forms submitted through the appropriate channels to the appropriate vice president by May 1. Use the Employee Development form to set goals.

>>See job performance evaluation supplement page if there are more than 6 duties to evaluate.

Contact Human Resources Lana.Anthis@wichita.edu or call (316) 978-6166; Matthew.Johnston@wichita.edu or call (316) 978-6123; or Frankie.Kirkendoll@wichita.edu or call (316) 978-3540 for assistance. 

 >>See Academic Affairs website for the correct form for a UP in Academic Affairs.

 

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Unclassified Professional Hire Packet PDF documents may be printed and completed in the department and sent with the unclassified professional to HR. This new set of self-extracting documents has been developed by ITS and is an approved replacement for the previous Excel spreadsheets. If you have one of the previous Excel spreadsheets, please stop using it and delete it from your computer. PDF
Unclassified Professional Request for Grievance

This document to be completed by the Unclassified Professional who wishes to submit a grievance.  The form can be completed on your computer and printed off, signed and submitted to the Director of Human Resources or the Executive Director of EEO. >>See Section 6.13 of the WSU Policies & Procedures Manual in regard to grievance procedures.

Note: The Word document will "grow" to accommodate the information as you fill in the yellow shaded portion on your computer.  You may check the "highlight text" box  at the top right of the Adobe document to clearly see which areas are to be completed; but the fields will not "grow" with your text -- attach additional pages as needed.

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University Support Staff Employee Evaluation & Development System (CEEDS) CEEDS is now PMP.  >> See Performance Management Process for more information.  
University Support Staff Grievance Request This form to be completed by University support staff employee who wishes to file a grievance.   >> See the complete University Support Staff Grievance Procedure handbook. PDF
University Support Staff Position Description The University Support Staff Position Description (revised: 07/28/14) has been formatted to follow the fields in PeopleAdmin. The form is in a Word table format that will "grow" to fit the information you type in. Assistance and direction for writing position descriptions will be provided by Human Resources. Contact Libby.Gilbert@wichita.edu or call (316) 978-6124. Word
W-2 Electronic W-2 is available.  >>See more to consent to electronic W-2 form.  
W-5, Advance Earned Income Credit Do you qualify for Earned Income Tax Credit?  
Withholding Tax, State K-4 Complete this form to change number of dependents for State income tax withholding from employee's salary.  (Instructions are included on the form.) *PDF
Withholding Tax, Federal W-4 Complete this form to change number of dependents for income tax withholding from employee's salary.  (Instructions are included on the form.) *PDF
Workers Compensation Employee Accident or Illness Report Complete this form within 3 days of any work-related accident or illness.

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Workers Compensation Mileage

Complete this form to report trips in excess of 5 miles in connection with your Workers Comp claim.

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Reviewed: 09/05/2014 SK