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.
Employment Action Form/One Time Payment – Revised 06/10/2014
Employment Action Form Instructions
Electronic Personnel Action Form (EPAF) User Manual (Rev. Jan 2023)
Job Analysis Questionnaire
Employment
PeopleAdmin
Timekeeping & Leave
– Monthly Time Record/Sheet
– Staff Leave Request Form
– Compensatory Time Report
– Application for Leave of Absence Without Pay
– Faculty Absence Request
– Personal/Major Medical Leave Form
– Family Medical Leave/Medical Leave of Absence
– FMLA Medical Certification Form for Employees
– FMLA Medical Certification Form for Family Members
– Regular Major Medical Certification Form
– Excuse/Release to Work
Student Employment
– New Work Study Student (WSR) Employment Packet – Revised August 2023
– New Regular Student Employee (RSE) Employment Packet – Revised August 2023
– Graduate Assistant (GA) Employment Packet & Information
– Student Employment Code of Responsibility and Confidentiality Agreement – New August 2021
Scholarships
– Application for Employee Tuition Remission Form
– Application for Dependent Child Tuition Remission Form
– Application for Spouse Scholarship Form
– Tuition Remission Drop Course Form
– Community College Faculty/Staff Scholarship Form
– Mississippi Delta Community College Dependent Student Scholarship Form
– Textbook Scholarship Program Application
Human Resources
– Americans with Disabilities Act Form
– Employee Information Form
– Change of Address Form
– Outside Employment Form
– Direct Deposit Form
– Faculty Pay Distribution Agreement
– Veteran Status Form
– Selective Service Form
– Staff Evaluation Form
– Hourly Performance Evaluation Form
– Performance Improvement Plan Form
Benefits
Southern Administrators and Benefit Consultants (Cafeteria Plan)
– Request for Reimbursement
– Dependent Care Receipt Form
– Change of Status Form
Delta Dental Insurance
– Enrollment Form
Beam Vision Insurance
– Enrollment Form
State of Mississippi Health Insurance Forms
– State Health Insurance Application Form
– State Health Medical Claim Form
State of Mississippi Life Insurance Forms
– State of MS Life Insurance Enrollment and Change Request Form
Public Employees’ Retirement System Forms
– PERS Enrollment, Membership Application, Form 1
– PERS Beneficiary Designation, Form 1B
– PERS Change of Information, form 1C
– PERS Reemployment of PERS Service Retiree, Form 4B
– Non-Covered Employment Acknowledgement, Form 4A
– Membership Refund Application, Form 5
– Pre-Application for Service Retirement Benefits, Form 9A SRVC
Drug and Alcohol Testing
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.
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