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Human Resource Forms

Click on the desired title to access the form. The PDF format forms can be viewed and printed using the free Adobe Acrobat Reader. If you do have the reader, you may download from the link below.

 

 FORM Format
   
Human Resource Forms  

The Employment Action Form replaces the Recommendation and Authorization Form, Change of Status Form and the Wage and Hour Appointment/Change of Status Form

  
Employment Action Form  
Employment Action Form Instructions  
 

 		  
   
Staff Merit Evaluation Form  
   
New! Outside Employment Form  
   
Employment Application PDF
Temporary Employment Packet PDF
Employee Information Form PDF
Direct Deposit Form PDF
   
Employee Requisition Forms  
Position Request Form  
Position Review Process  
Compensatory Time Record Excel
Monthly Time Record/Sheet Excel
   
Family Medical Leave/Medical Leave of Absence Excuse/Release to Work  

Medical Certification for Major Medical Leave
Family Medical Leave/Medical Leave of Absence
Excuse/Release to Work

  html
 
  
Request for Leave  
Staff Leave Request Form html
Application for Leave of Absence Without Pay html
Teacher Absence Request Word
   
Tuition Remission Forms  

Application for Employee Tuition Remission Form

 html
Application for Dependent Child Tuition Remission Form html
Application for Spouse Scholarship Form Word
Tuition Remission Drop Course Form Word
   
Personal/Major Medical Leave Form PDF

Termination/Clearance Form

 html
Americans with Disabilities Act Form html
Veteran Status Form html
Selective Service Form Word
Reference Checking Form html
Reference Check Release From html
Faculty Pay Distribution Agreement Word
Textbook Scholarship Program Application Word
State of Mississippi New Hire Reporting Form  Adobe
   
Tax Forms  
Federal Tax Form PDF
State Tax Form PDF
   
   
Immigration and Naturalization  
I-9 Employment Verification Eligibility (Fill-in format) PDF
I-9 Employers Handbook - Instructions for completing the Form I-9 PDF
   
Workman's Compensation  
Workers' Compensation First Report of Injury(fill-in format) PDF
   
Employee Benefit Concepts  
Mediflex Claim Form  
Cafeteria Plan Revocation/Change Form  
   
State of Mississippi Health Insurance Forms  
State Health Insurance Application Form PDF
Blue Cross Blue Shield Change of Address Form  PDF
State Health Medical Claim Form PDF
Catalyst Rx Direct Member Reimbursement Form PDF
PDF
Walgreens Mail Service Registration and Prescription Order Form PDF
   
State of Mississippi Life Insurance Forms  
State of MS Life Insurance Enrollment and Change Request Form PDF
   
   
Public Employees' Retirement System Forms  
PERS Enrollment Form PDF
PERS Beneficiary Nomination Form PDF
PERS Change of Information PDF
PERS Certification/Acknowledgement of Reemployment Form PDF
Noncovered Acknowledgement Form PDF
Application for Refund of Accumulated Contributions to Member PDF
Pre-Application for Service Retirement Benefits PDF

 

 

Delta State University is committed to a policy of equal employment and educational opportunity. Delta State University does not discriminate on the basis of race, color, religion, national orgin, sex, age, disability, or veteran status. This policy extends to all programs and activities supported by the University.

 

 


This site is maintained by Lisa Giger. Send questions and comments regarding this site to lgiger@deltastate.edu

 

 

 

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