• General Forms

• Application for Employment
• College Assistant Work Schedule Confirmation
• Full Time Appointment
• HEO Package
• Inter-College Transfer Application
• Medical Inquiry Form (In Response to an Accommodation Request)
• Multiple Positions Form
• Performance Correction Notice
• Personnel & Payroll Processing of Appointments
• Reference Check
• Request for Reasonable Accommodation
• Request for Waiver of the ByLaws
• Section 211 Waivers (Approval Request Form)

• Benefits

City Health Benefits

• Basic Plan and Optional Rider Costs for Employees
• Health Benefits Application with Instruction Sheet
• Health Plan Rate 2011

Ending Employment Forms

• COBRA Notice of Rights and Health Benefit Rates
• DC 37 (link to another site)
• PSC CUNY (link to another site)
• ARRA COBRA Application (PSC CUNY)
• Exit Clearance Sign-off
• Exit Interview Form
• Travia Leave Application

Flexible Spending Account Forms

• DeCAP Claim form
• FSA Flyer
• FSA Program Fact Sheet
• HCFSA Claim form
• Plan Year 2013 FSA Enrollment/Change Form
• Plan Year 2013 FSA Program Brochure
• Plan Year 2013 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
• Plan Year 2013 MSC Premium Conversion Enrollment/Change Form
• Plan Year 2013 HCFSA/DeCAP SPD
• Plan Year 2013 HCFSA/HIPPA
• Plan Year 2013 MSC SPD

FMLA Forms

• CUNY Certification of Health Care Provider for Family Members Serious Health Condition form
• CUNY Certification of Qualifying Exigency for Military Family Leave form
• CUNY Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave form
• Paid Parental Leave (PSC only)
• Request for Family Medical Leave (FML)

Other Benefits Forms

• Domestic Partnership Packet
• Hearing Aid Reimbursement Form
• GHI Health & Wellness GHI Discount Programs
• Long-Term Disability Benefits Claim Packet (PSC CUNY)
• NYCERS Loan Application
• Park-N-Ride Plan Enrollment Form
• Retiree Change of Address Form
• Short-term Disability Benefit Claim Form (DC 37)
• TransitBenefit Enrollment Form
• Weight Watchers Reimbursement Form

Pre-Tax Savings Plans

• HRC Salary Reduction form
• MetLife Salary Reduction form
• New York 529 College Savings Enrollment Application
• New York 529 College Savings Payroll Deduction form
• TIAA Salary Reduction form

Retirement Forms

• Application for Retirement
• Monthly Health Plan Rates- Medicare and Non- Medicare Eligible Retirees and Their Dependents
• PSC-CUNY: Retiree Enrollment Questionnaire
• Retiree Change of Address Form
• Social Security Presentation
• TIAA-CREF Medicare-Eligible Retirees Application for Medicare (Part B) Reimbursement

Worker’s Compensation Forms

     Employees should be filled out with a dark pen and legible (please print).

• Worker’s Compensation Election of Options (DP-2002)
• Worker’s Compensation Employee Incident Report
• Worker’s Compensation Employee's Statement of Injury

     Supervisors must fill out and forward to HR the following forms within 48
     hours of the injury/illness:

• Worker’s Compensation Accident Description Codes
• Worker’s Compensation Supervisor's Report of Injury
• Worker’s Compensation Witness Statement

• Overtime, Time & Leave

• Application for Child Care Leave of Absence
• Application for Leave
• Application to Receive Dedicated Sick Leave
• Application to Dedicated Sick Leave
• Compensatory Time Authorization Form - Classified Staff
• Exit Interview Form
• Fellowship Leave Application
• Paid Overtime Approval Form (Classified Staff)
• Request for Pre-Approval of Extended Hours (HEO Series)
• Summer Hours Four Day Work Week
• Summer Hours Program Options
• Weekly Timesheet for HEO Series Staff
  (A required form to support a submitted request for pre-approval of extended hours)

• Training & Development

• Citywide Training Center Application (NYC Department of Citywide Administrative Services)
• Program/Course Application (OHRM Professional Development & Learning Management Office)
• Tuition Fee Waiver