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413 538-2503 Human Resources
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Human Resources Forms

Instructions: All forms in PDF Format, unless otherwise noted.
Print a blank form and fill it in manually, or download the file to your desktop and complete as a Word document. Please forward all completed forms to the Human Resources Department.

Domestic Partner Domestic Partner Affidavit
Domestic Partner Termination Request
Employee Info/
Employment
Demographic Change Form
Employment Application
EEO Information Request
Employee Conference
Flexible Spending

Flexible Spending Account Direct Deposit
Flexible Spending Account Enrollment
Flexible Dependent Care Worksheet
Flexible Health Care Worksheet
Flexible Spending Reimbursement
Flexible Spending Accounts Booklet 2008
Qualified Status Change Event
Notice of Continuation of Benefits

Dental & Health Insurance Delta Dental
Health Insurance Premium Subsidy
Health Insurance Premium Subsidy - (Word)
Blue Cross/Blue Shield Enrollment & Change
Tufts Enrollment & Change
Payroll

Direct Deposit
OneCard Authorization
Federal Tax (W4)
Massachusetts State Tax (M4)
Federal Employment Eligibility (I9)

Performance Management Performance Management Community Reference Guide
Performance Management Evaluation - Narrative
Performance Management Evaluation - Original
- (Word)
Revised Simplified Performance Evaluation - (Word)
Retirement Application for Pension Plan
Basic & Supplemental Retirement Annuities
Life & LTD Election
Salary Administration Job Analysis - (Word)
Student Payroll

Student Direct Deposit
Student Direct Deposit Cancellation
Student Timesheets

Tuition

Employee Tuition Reimbursement
Tuition Exchange Application
Tuition Exchange Recertification
Tuition Grant Application
Tuition Waiver Application

Worker's Compensation

Employer's First Report of Injury or Fatality
Supervisor's Accident Investigation Report
Supervisor's Accident Investigation Report - (Word)
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.
Worker's Compensation Medical Release
Worker's Compensation Medical Treatment

 



 

 


 

 

Human Resources
Mount Holyoke College, 50 College Street South Hadley, MA 01060-1453
Phone: 413-538-2503

Copyright © 2008 Mount Holyoke College. This page created by MHC Web Strategy Team and maintained by Carmen Jimenez. Last modified on May 8, 2008.