{"id":8,"date":"2017-03-27T19:01:13","date_gmt":"2017-03-27T19:01:13","guid":{"rendered":"https:\/\/www.deltastate.edu\/humanresources\/?page_id=8"},"modified":"2026-04-16T13:32:05","modified_gmt":"2026-04-16T13:32:05","slug":"human-resource-forms","status":"publish","type":"page","link":"https:\/\/www.deltastate.edu\/human-resources\/human-resource-forms\/","title":{"rendered":"Human Resources Forms"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; 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<\/div><\/div><div class=\"container\">\r\n\t\t\t\t\t\t<div class=\"content\"><p class=\"transparent-bg\" ><span>Human Resources<\/span><\/p><\/div>\r\n\t\t\t\t\t\t\t\t<\/div><!--\/container--><div class=\"video-texture \"> <span class=\"ie-fix\"><\/span> <\/div><\/div> <!--\/swiper-slide--><\/div><div class=\"nectar-slider-loading \"> <span class=\"loading-icon none\">   <\/span> <\/div> <\/div> \r\n\t\t\t\t\t\r\n\t\t\t\t\t<\/div><\/div>[\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h1>Human Resources Forms<\/h1>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<p style=\"text-align: left;\" align=\"center\">Click on the desired title to access the form.\u00a0The 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.<\/p>\n<p style=\"text-align: left;\" align=\"center\"><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/EPAFs-EAFs-Training-Handout.pdf\">EPAF or EAF? &#8211; What to use guidelines:<\/a><\/p>\n<ul>\n<li><a href=\"https:\/\/www.deltastate.edu\/MSDocs\/human-resources\/Employment-Action-Form_REV06102014_wprotection.xls\">Employment Action Form\/One Time Payment<\/a>\u00a0\u2013 Revised 06\/10\/2014<\/li>\n<li><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Employment%20Action%20Form_instructions.doc\">Employment Action Form Instructions<\/a><\/li>\n<li><a href=\"http:\/\/www.deltastate.edu\/docs\/human_resources\/EPAF-User-Manual_January-2022.pdf\">Electronic Personnel Action Form (EPAF) User Manual (Rev. Jan 2023)<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Hiring-Procedures-Rev-11-24.pdf\">Hiring Procedures<\/a><\/p>\n<ul>\n<li><a href=\"https:\/\/deltastate.kualihub.com\/app\/698e2791ca86fd028aa3685d\/run\">Click Here to access and complete the <strong>Position Request Form<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/deltastate.kualihub.com\/app\/69bc2871689a750292d36f29\/run\">Click Here to access and complete the <strong>Request to Hire Form<\/strong><\/a><\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Time-and-Leave-Training-Document.pdf\">How To Enter Time and Leave Requests (for Monthly Employees)<\/a>[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;50&#8243;][vc_row_inner column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; text_align=&#8221;left&#8221;][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/3&#8243; tablet_width_inherit=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h2 style=\"text-align: center;\">Job Analysis Questionnaire<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/DSU%20JAQ.docx\">Job Analysis Questionnaire<\/a><\/p>\n<p><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/DSU-JAQ-Explanation-Justification-07-2023.docx.docx\">Job Analysis Questionnaire Change Explanation Justification<\/a> &#8211; <strong><em>This form must be submitted to HR with the revised JAQ\u00a0 for any request to evaluate changes to existing JAQs.<\/em><\/strong>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_column_text]\n<h2 style=\"text-align: center;\">Employment<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Adjunct-Packet-Rev-1-2026.pdf\">Adjunct Employment Packet\u00a0<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Temporary-Employee-Packet-Rev-1-2026.pdf\">Temporary Employment Packet<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/employee_information_form_REV1222.doc.doc\"> Employee Information Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Reference%20Check%20Release%20Form2.doc\"> Reference Check Release From<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Reference%20Checking%20Form2.doc\">Reference Checking Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/MS_Form.pdf\">State of Mississippi New Hire Reporting Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/W-4-tax-form-2026.pdf\">Federal Tax Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/human-resources\/wp-content\/uploads\/sites\/57\/2017\/03\/MS-State-Tax-Form-2020-Typeable.pdf\" target=\"_blank\" rel=\"noopener\"> State Tax Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.uscis.gov\/sites\/default\/files\/files\/form\/i-9.pdf\"> I-9 Employment Verification Eligibility <\/a>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_column_text]\n<h2 style=\"text-align: center;\">PeopleAdmin<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<a href=\"https:\/\/www.deltastate.edu\/human-resources\/wp-content\/uploads\/sites\/57\/2017\/03\/2017-PeopleAdmin-User-Guide.docx\"><strong>PeopleAdmin User Guide<\/strong><\/a>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_text_separator title=&#8221;&#8221; color=&#8221;white&#8221;][vc_column_text]\n<h2 style=\"text-align: center;\">Timekeeping &amp; Leave<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/finance\/wp-content\/uploads\/sites\/10\/2013\/06\/Time_Record_Overtime_Monthly_with_protection.xls\" target=\"_blank\" rel=\"noopener\"> Monthly Time Record\/Sheet<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Staff-Request-for-Leave-0321.docx\"> Staff Leave Request Form<\/a><br \/>\n<strong>&#8211; <\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Time_Record_Comp_Monthly.xlsx\">Comp Time Earned Record (Monthly Employees)<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Application%20for%20Leave%20Without%20Pay3.doc\">Application for Leave of Absence Without Pay<\/a><br \/>\n<strong>&#8211;<\/strong> <a title=\"Sample Teacher Absence Form\" href=\"https:\/\/www.deltastate.edu\/human-resources\/wp-content\/uploads\/sites\/57\/2017\/03\/Faculty-Absence-Request.docx\">Faculty Absence Request<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/persona_leave_record2.xls\" target=\"\" rel=\"noopener\">Personal\/Major Medical Leave Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/MSDocs\/h_r\/Employee_Application_FMLA_MMedical_Leave022017.doc\">Family Medical Leave\/Medical Leave of Absence<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.dol.gov\/whd\/forms\/WH-380-E.pdf\">FMLA Medical Certification Form for Employees<\/a><a href=\"https:\/\/www.dol.gov\/whd\/forms\/WH-380-F.pdf\">\u00a0<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.dol.gov\/whd\/forms\/WH-380-F.pdf\">FMLA Medical Certification Form for Family Members<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/MSDocs\/h_r\/Major_Medical_Certification-for-Major-Medical-Leave_Doctor_Form.doc\"> Regular Major Medical Certification Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/MSDocs\/h_r\/Major_Medical_Certification-for-Major-Medical-Leave_Doctor_Form.doc\">Excuse\/Release to Work<\/a>[\/vc_column_text][\/vc_column_inner][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/3&#8243; tablet_width_inherit=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h2 style=\"text-align: center;\">Student Employment<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/2025_FWS_NewHirePacket.pdf.pdf\"> New Work Study Student (WSR) Employment Packet<\/a> &#8211; Revised January 2025<br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/2025_RSE_NewHirePacket.pdf.pdf\"> New Regular Student Employee (RSE) Employment Packet<\/a> &#8211; Revised January 2025<br \/>\n<strong>&#8211; <\/strong><a href=\"https:\/\/www.deltastate.edu\/graduate-and-continuing-studies\/graduate-assistantships\/\">Graduate Assistant (GA) Employment Packet &amp; Information<\/a><br \/>\n<strong>&#8211; <\/strong><a href=\"http:\/\/www.deltastate.edu\/PDFFiles\/Human Resources\/Student-Employment-Code-of-Responsibility-and-Confidentiality-Agreement.docx.pdf.pdf\">Student Employment Code of Responsibility and Confidentiality Agreement<\/a> &#8211; New August 2021<\/p>\n<p><strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/PDFFiles\/Human%20Resources\/Student-Employment-HandbookFinalCopy.pdf.pdf\">Student Employment Handbook<\/a><br \/>\n<strong>&#8211; <\/strong><a href=\"https:\/\/www.deltastate.edu\/PDFFiles\/Human%20Resources\/Student-EPAF-Manual-August-2021.pdf.pdf\">Student EPAF User Manual<\/a>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_column_text]\n<h2 style=\"text-align: center;\">Scholarships<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/employee_tuition_remission_app-Rev.042024.doc\"> Application for Employee Tuition Remission Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/dependent_child_tuition_remission_app_rev072024.doc\"> Application for Dependent Child Tuition Remission Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/spouse_tuition_remission_app_rev072024.doc\"> Application for Spouse Scholarship\u00a0Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/employee_tuition_remission_drop_app-Rev052022.doc.doc\"> Tuition Remission Drop Course Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Mississippi-Community-College-Tuition-Remission-Form-Rev0524.pdf\"> Community College Faculty\/Staff Scholarship Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/mdccsdependentscholarship.doc\"> Mississippi Delta Community College Dependent Student Scholarship Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/BookScholarship.doc\"> Textbook Scholarship Program Application<\/a>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_column_text]\n<h2 style=\"text-align: center;\">Human Resources<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Americans-with-Disabilities-Act-Form-2025.doc\"> Americans with Disabilities Act Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Employee%20Information%20Form.doc\"> Employee Information Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Change-of-Address-Form-Rev03-2021-Fillable.pdf\">Change of Address Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/OUTSIDE_EMP_DSU.pdf\">Outside Employment Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/human-resources\/wp-content\/uploads\/sites\/57\/2017\/03\/direct_deposit-Rev-10-2019-.doc\">Direct Deposit Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Veterans%20Form_0107.doc\">Veteran Status Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/SELSERFORM.doc\">Selective Service Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/StaffEvaluationForm2023-2024.doc\">Staff Evaluation Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/HourlyEvaluationForm2023-2024.doc\"> Hourly Performance Evaluation Form<\/a><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.deltastate.edu\/finance\/wp-content\/uploads\/sites\/10\/2013\/06\/Performance-Improvement-Plan-2017.doc\"> Performance Improvement Plan Form<\/a>[\/vc_column_text][\/vc_column_inner][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/3&#8243; tablet_width_inherit=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h2 style=\"text-align: center;\">Benefits<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>Southern Administrators and Benefit Consultants (Cafeteria Plan)<\/strong><br \/>\n<strong>&#8211;<\/strong><a href=\"https:\/\/www.sabcflex.com\/content\/employee-services\"> Request for Reimbursement<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.sabcflex.com\/content\/employee-services\">Dependent Care Receipt Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.sabcflex.com\/content\/employee-services\">Change of Status Form<\/a><br \/>\n<strong>Delta Dental Insurance<\/strong><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/DELTA%20DENTAL.pdf\">Enrollment Form<\/a><br \/>\n<strong>Beam Vision Insurance<\/strong><br \/>\n&#8211; <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Beam-Vision-Application-form-2019.pdf\">Enrollment Form<\/a><br \/>\n<strong>State of Mississippi Health Insurance Forms<\/strong><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/Health-Insurance-Application-for-Coverage.pdf\">State Health Insurance Application Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/medical_bcbs_claim_form.pdf\">State Health Medical Claim Form<\/a><br \/>\n<strong>State of Mississippi Life Insurance Forms<\/strong><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/docs\/human_resources\/State-of-MS-Life-Insurance.pdf\" target=\"\" rel=\"noopener\">State of MS Life Insurance Enrollment and Change Request\u00a0Form<\/a><br \/>\n<strong>Public Employees\u2019 Retirement System Forms<\/strong><br \/>\n<strong>&#8211;<\/strong><a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\" target=\"\" rel=\"noopener\"> PERS Enrollment, Membership Application, Form 1<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\" target=\"\" rel=\"noopener\">PERS Beneficiary Designation, Form 1B<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\">PERS Change of Information, form 1C<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\">PERS Reemployment of PERS Service Retiree, Form 4B<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\" target=\"\" rel=\"noopener\">Non-Covered Employment Acknowledgement, Form 4A<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\" target=\"\" rel=\"noopener\">Membership Refund Application, Form 5<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"http:\/\/www.pers.ms.gov\/Content\/Pages\/Forms.aspx\" target=\"\" rel=\"noopener\">Pre-Application for Service Retirement Benefits, Form 9A SRVC<\/a>[\/vc_column_text][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;30&#8243;][vc_column_text]\n<h2 style=\"text-align: center;\">Drug and Alcohol Testing<\/h2>\n[\/vc_column_text][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/finance\/wp-content\/uploads\/sites\/10\/2013\/06\/Reasonable-Suspicion-Form.docx\">Reasonable Suspicion Form<\/a><br \/>\n<strong>&#8211;<\/strong> <a href=\"https:\/\/www.deltastate.edu\/finance\/wp-content\/uploads\/sites\/10\/2013\/06\/Prescription-Drug-Disclosure-form.docx\">Prescription &amp; Non-Prescription Drug Voluntary Disclosure Form<\/a>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][divider line_type=&#8221;Full Width Line&#8221; line_thickness=&#8221;1&#8243; divider_color=&#8221;default&#8221; custom_height=&#8221;10&#8243;][vc_column_text]\n<p align=\"center\">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 origin, sex, age, disability, or veteran status. This policy extends to all programs and activities supported by the University.<\/p>\n<p align=\"center\">Send questions and comments regarding this site to Human Resources.<\/p>\n[\/vc_column_text][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221;&#8230;<\/p>\n","protected":false},"author":530,"featured_media":0,"parent":0,"menu_order":99,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-8","page","type-page","status-publish"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/pages\/8","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/users\/530"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/comments?post=8"}],"version-history":[{"count":11,"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/pages\/8\/revisions"}],"predecessor-version":[{"id":1427,"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/pages\/8\/revisions\/1427"}],"wp:attachment":[{"href":"https:\/\/www.deltastate.edu\/human-resources\/wp-json\/wp\/v2\/media?parent=8"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}