Forms

Please send all completed forms to Human Resources. 

Benefits

Dental and Health Insurance

• Blue Cross/Blue Shield Enrollment & Change
• Fitness Center Reimbursement
  

Domestic Partner 

• Affidavit
• Termination 

Flexible Spending

• Direct Deposit 
• Enrollment 
• Dependent Care Worksheet 
• Health Care Worksheet
• Accounts Booklet  
• Qualified Status Change Event 
• Notice of Continuation of Benefits
• mySourceCard™ Enrollment Agreement 
• On-line Reimbursement Claim
• Reimbursement Claim

 

Retirement, Life Insurance & Long-Term Disability Insurance

• Cash Balance Retirement Plan Enrollment
• Payroll Deduction / Reduction Form
• Summary Plan Description Defined Benefit (Cash Balance) Plan
• Summary Plan Description for Defined Contribution Plan(s)
• Life & LTD Enrollment
• Summary Plan Description Basic Life Insurance
• Summary Plan Description Supplemental Life Insurance
• Statement of Health
• Summary Plan Description Union Employees
• Summary Plan Description Non-Union Employees

Staff Leave

• Staff Leave Donation Policy and Form 
• Parental Leave Policy and Form

Tuition

• Employee Enrollment (sample)
• Dependent Enrollment
• Frances Perkins Enrollment (sample)
• Employee Reimbursement
• Exchange Application
• Graduate Program Enrollment (sample)
• Exchange Recertification 
• Waiver Application 

Employment

• Demographic and Online Directory Information
• Employment Application
• EEO Information Request
• Employee Conference  

Payroll

Student Payroll 

• Direct Deposit
• Direct Deposit Cancellation
• Timesheets

Faculty and Staff

• Direct Deposit
• Federal Tax (W4)
• Massachusetts State Tax (M4)
• Federal Employment Eligibility (I9)
• Spanish I9 (for reference only)
• Personnel Action Form  (sample)
  Note: This is a carbon-copy form and is available in the Human Resources Department.
• Web-Time Entry Instructions for Employees
• Web-Time Entry Instructions for Supervisors
• Web-Time Entry FAQs for Employees
• Web-Time Entry FAQs for Supervisors

Performance Management 

• Community Reference Guide
• Evaluation - Narrative
• Evaluation - Original 
• Evaluation - Revised Simplified 

Salary Administration 

• Job Analysis 
• Salary Grade Range Chart 

Worker's Compensation

• Employer's First Report of Injury or Fatality- Form 101
• Supervisor's Accident Investigation Report  [PDF - print and fill-out by hand]
• Supervisor's Accident Investigation Report  [Word doc - fill-out on computer, then print]
  
  Note: This form documents the supervisor's investigation and needs to be submitted after the investigation is complete and within 7 calendar days of the accident.
• Medical Treatment
• Medical Release