Froms Library
Benefits
Compensation
Data Management
Employee/ Labor   Relations
Workforce   Management
Miscellaneous

The following forms are presently available as Adobe Acrobat PDF files which require that you have the Acrobat Reader installed on your computer. If you do not have the Acrobat Reader, you can download a free copy from the Adobe Website by clicking the graphic shown.Adobe Acrobat Reader

Fillable forms can be completed on-line and then printed for required signatures. Please note that the information entered in the fillable pdf may be saved ONLY if you have Adobe Acrobat 6.0 Pro or greater installed on your computer.

Non-fillable forms should be printed, completed, and returned to the Division of Human Resources at 2033 K St., NW, Suite 220, Washington, DC 20052.

Benefits Administration
Medical Insurance
Adobe Acrobat Reader
 Medical Enrollment (2008 Benefits Enrollment Form)
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 CareFirst BlueCross Blue Shield Claim Form
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 CareFirst BlueCross Blue Shield student certification
Adobe Acrobat Reader
 CareFirst BlueCross Blue Shield disability certification
Adobe Acrobat Reader
 Cigna Medical Claim Form
Adobe Acrobat Reader
 Health Insurance Waiver Form
Life Insurance
Adobe Acrobat Reader
 Beneficiary Designation Form for Basic Life Insurance
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 Beneficiary Designation Form for Supplemental Life Insurance
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 Evidence of Insurability
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 Short Term and Long Term Disability Enrollment Form
Prescription Drug Program
Adobe Acrobat Reader
 Caremark Prescription Claim Form
Adobe Acrobat Reader
 Caremark Prescription Mail Order Form
Dental Insurance
Adobe Acrobat Reader
 Aetna Dental Enrollment Form (2008 Benefits Enrollment Form)
Adobe Acrobat Reader
 Aetna Dental Claim Form
Flexible Spending Accounts
Adobe Acrobat Reader
Flexible Spending Accounts Enrollment (2008 Benefits Enrollment Form)
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 2007 Flexible Spending Account Request for Reimbursement Form
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 2008 Flexible Spending Account Request for Reimbursement Form
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 Flexible Spending Direct Deposit Authorization Form
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 Additional or Duplicate Debit Card Request Form
Retirement
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 2008-- 403(b) Salary Reduction Agreement
Tuition Benefits
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 Tuition Benefits Application
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 Faculty and Staff Certification of Graduate Tuition Benefits
Adobe Acrobat Reader
 Research Personnel Certification of Graduate Tuition Benefits
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 Tuition Exchange (The open enrollment period for Tuition Exchange is presently closed)
Declaration
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 Declaration of Common Law Marriage
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 Declaration of Domestic Partnership
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 Declaration of Marriage
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 Declaration of Dependent Children
HIPPA
Adobe Acrobat Reader
 Authorization Form for the Release of Protected Health Information
Adobe Acrobat Reader
 Plan Member Request for Account of Disclosures of Protected Health Information
Adobe Acrobat Reader
 Plan Member Request for Alternative Method for Confidential Communication of Protected Health Information
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 Plan Member Request to Access Protected Health Information
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 Plan Member Request to Correct or Amend a Record
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 Group Health Plan's Response to Request for Confidential Communications of Protected Health Information
Adobe Acrobat Reader
 Group Health Plan's Response to Request to Restrict Use or Disclosure of Protected Health Information
Transportation Benefits
Adobe Acrobat Reader
 Pre-tax Transportation Benefit Plan Enrollment/Change Form


Compensation
Adobe Acrobat Reader
 Request for Lump Sum Bonus Payment
Adobe Acrobat Reader
 Request for Premium Pay


Data Management
Adobe Acrobat Reader
 Employment Eligibility Verification Form
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 Employee Data Questionnaire
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 Employee Data Change Request
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 Declaration of Marriage
Adobe Acrobat Reader
 BANNER Access Request Form
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 On-Line Directory Departmental Administrator Request Form - coming soon
Adobe Acrobat Reader
 Affiliate NetID Request Form
Adobe Acrobat Reader
 Request to Review Employee Record - coming soon
Adobe Acrobat Reader
 Request Employee Data File, Labels  or Report


Employee and Labor Relations
Adobe Acrobat Reader
 Leave
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 Performance Evaluation Form for Non-Exempt Employees
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 Performance Evaluation Form for Exempt Employees
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 Performance Evaluation Form for Managerial/Supervisory Employees
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 Self- Evaluation Form for Non-Exempt Employees
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 Self-Evaluation Form for Exempt Employees
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 Self-Evaluation Form for Managerial/Supervisory Employees


Workforce Management
Adobe Acrobat Reader
 Employee Hire Form
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 Change in Status Form
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 Request to Extend a Temporary/ Wage Account Position
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 Request for Employment in More Than One Position
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 I-9 Form

Miscellaneous
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 Flex Time Request Form
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 Adjusted Meal Period Request From
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 Compressed Work Week Request Form
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 Compressed Two-Week Request From
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 Telecommuting Agreement
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 Direct Deposit    (Payroll)
Adobe Acrobat Reader
 U.S. Federal Tax Withholding/Exemption Form W-4   (Payroll)
Adobe Acrobat Reader
 District of Columbia Form D-4   (Payroll)
Adobe Acrobat Reader
 District of Columbia Certificate of Non-Residence (D-4A)   (Payroll)
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 State of Maryland Form MW507   (Payroll)
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 Commonwealth of Virginia Form VA-4   (Payroll)
Adobe Acrobat Reader
 West Virginia Employee Withholding Exemption Certificate   (Payroll)

 Division of Human Resources
 
Foggy Bottom Campus, 2033 K Street, NW, Suite 220, Washington DC 20052
Phone: (202) 994-9600 Fax: (202) 994-9619 Email: dhr@gwu.edu
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