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UNR Forms

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Form title Description 1-Leave Request Form Faculty/Classified- Use this form to submit a request for sick or annual leave. 2009 Academic "B" Faculty automated Attendance Leave Record Form UNR Form B-Faculty Automated Leave Record Form 2009 Academic "B" Part-Time Faculty automated Attendance Leave Record Form UNR Form Part-Time B-Faculty Automated Leave Form 2009 AD & AC "A" Faculty automated Attendance Leave Record Form UNR Form A-Faculty Automated Leave Record Form 2009 AD & AC "A" Part-Time Faculty automated Attendance Leave Record Form UNR Form Part-Time A-Faculty Automated Leave Record Form 2009 Post Doc Attendance Leave automated Record Form UNR Form Post Docs - Automated Leave File Academic Faculty Evaluation UNR Form Faculty-annual evaluation and merit review form (January 1 through December 31) Administrative Faculty Evaluation UNR Form Faculty-annual evaluation and merit review form (January 1 through December 31) Procedures Conflict of Interest Form Example Goal Statement Alcohol / Drug Free Workplace Policy UNR Employees - Policy statement regarding the use of Alcohol and Drugs. Must be completed upon hire. Attendance Leave Record Form Faculty/Classified - Leave record keepers may use this form to calculate monthly leave balances. Brief Ad Format UNR - This is the format used for your print advertising. CAT Leave - Policy and General Procedures Policy - Classified employees can refer to the UNR Catastrophic Leave – Policy and General Procedures. Educational Leave Stipend Application Form used by Classified employees working toward a degree Educational Leave Stipend Program Terms and Conditions Terms and Conditions for submitting an Educational Leave Application EEO/AA Statement for Ad/Announcement Copy UNR - One of these two statements is required to be on all ad/announcement copy. Eligibility Application UNR Form for Student Employment Employee Separation Checklist Checklist should be utilized at separation of employee. For department and employee use only. The following is a list of items that may need attention or action from the department or the employee when leaving the department or the University. Employee Separation Notification Must be completed at separation of employee. Form alerts critical departments such as Human Resources, Payroll, Benefits, and Information Technology of the separation. Faculty Leave Records should be audited by the department leave keeper. A copy of the leave card/record (not leave requests) should be sent to Human Resources with the separation PAF. Evaluation Procedures for Administrative Faculty UNR Form Faculty Faculty Exit Questionnaire UNR Faculty Faculty Hiring Packet This is the hiring packet sent to the new faculty member. Now includes the 2008 w-4 and was last updated 12-14-2007. It should be used with the Faculty New Hire Checklist. - UNR Faculty New Hire Checklist Faculty New Hire Documents Q & A FICA Alternative Enrollment Form-Continuing Employee with SSA-1945 form attached FICA Alternative Form for Continuing Classified and Letter of Appointment Employees Continuing = has less than a one year break-in-service. FICA Alternative Enrollment Form-New Hire with SSA-1945 form attached Used by departments for hiring new Classified and Letter of Appointment Employees New = hired after 7/1/05 or has not been paid for one year. FICA Alternative Plan Information Sheet Description of FICA Alternative Retirement Plan for Classified and Letter of Appointment Employees. FICA Alternative Withdrawal Rules for Withdrawal from FICA Alternative Plan for Classified and Letter of Appointment Employees. FMLA - Certification of Health Care Provider NPD-61 - Form is completed by a health care provider to certify medical necessity for FMLA. NPD-61 FMLA - Employer Response for Classified Employees NPD-62 - This form is completed by the employer in response to a Classified employee's request for FMLA (Family and Medical Leave Act). FMLA - Employer Response for Faculty Employees NPD-62 - This form is completed by the employer in response to a Faculty employee's request for FMLA (Family and Medical Leave Act). FMLA - Request for FMLA Leave NPD-60 - Form is used for requesting a leave of absence und Family Medical Leave Act (FMLA) guidelines I9 Classified/Faculty - link to United States Citizenship and Immigration web site containing most recent Form I-9 I-9 Handbook for Employers PowerPoint: I-9 Training Materials PowerPoint: UNR Immigration Workshop Materials I-9 Update Memo LOA Hiring Packet This packet is for Letter of Appointment contracts (LAC/LOA, LBC/LOB, etc.) It should be used with the Faculty New Hire Checklist or the UNR Rehire Checklist. Faculty New Hire Checklist UNR Rehire Checklist Faculty New Hire Documents Q & A Moving Expenses For detailed information on the Moving Expense Policy, please visit the State Administrative Manual, section 0238.0 as well as, the UNR Administrative Manual, section 2540, page 166 Nepotism Form - Student Only required if closely related individuals to position in which one employee is in the line of supervision over the other employee Nevada Workplace Safety Form Must be completed upon hiring a new employee. New Hire Checklist - Faculty Used by departments hiring Faculty New Hire Checklist - Student UNR Form Used by UNR departments hiring students. New Hire Packet - Student For New Hire Student Employees New Hire Policies and Acknowledgement Forms NSHE Policy Against Sexual Harassment and Complaint Procedure, Nevada Work Place Safty and Policy Statement Alcohol/Drug Free Workplace. Notification of New Employee Form Must be completed upon hiring a new employee. Form alerts critical departments such as Human Resources, Payroll, Benefits, and Information Technology that there is a new hire. Oath Must be completed by all Faculty at new hire Overtime/Compensatory Time Tracking and Approval This form is completed by the employee and authorized by the supervisor for the tracking and reporting of overtme/compensatory time. Payroll/HR Cutoff Schedule Personal Data Form Completed by all employees at hire, including volunteers, and some demographic data changes Description of Military Veteran Status Personnel / Payroll Action Form (Faculty, Postdoctoral Fellows, Letter of Appointment, Medical Residents, Graduate Assistants) PAF - UNR Form: Completed by department for Faculty, Postdoctoral Fellows, Letter of Appointment, Medical Residents, Graduate Assistants new hires and any changes to pay status Personnel/Payroll Action Form (Classified & Students) PAF - UNR Form: Completed by department for Classified and Student new hires and any changes to pay status Position Description Questionnaire (Administrative Faculty) PDQ - UNR Form: Administrative Faculty Position Description Questionnaires (PDQ) are reviewed by the Administrative Salary Placement Committee for placement in the UNR Salary Schedule. PDQ Preparation and Routing Instructions. Power of Attorney Authorization for an alternate to sign specific documents in the absence of the employee Preemployment Certification UNR - All candidates approved for interview are required to complete and return this form to the Search Chair prior to being interviewed. See Search Process. All new letters of appointment must complete and and submit with new hire paperwork. Preparing Hiring Documents for Student Employees Training Module for Employers on how to prepare student employee hiring documents. President's Memo on a Drug Free Workplace Memo required to be distributed to New Employees Previously Employed Checklist - Student UNR Form: How to Hire a Student Previously Employed Packet - Student UNR Form: For previously employed student employees Procedure for a Student Employee Work Related Injury Describes the Nevada workers' compensation system Prohibitions & Penalties NSHE Document which clarifies existing policy, procedure and regulation. Signed by Classified employees at the time of hire. Quarterly Leave Orange Cards Faculty/Classified -Department record keepers use this form to calculate sick and annual leave quarterly (at the end of March, June, September, and December.) The employee should sign and return the card to the leave record keeper. Reference Authorization Form UNR Form: Used for Faculty Searches when performing references checks. Rehire Checklist- Faculty UNR Form: All forms needed when re-hiring a faculty employee at UNR Request for Establishment of Faculty Stipend Used to submit a request to establish a new stipend cell. For more information, view the Administrative Manual section # 2550 Request for Instructional Compensation- Administrative Faculty UNR Form: Faculty- Administrative faculty who want to engage in teaching activities at the request of an instructional unit of the University of Nevada, Reno Request for Moving Expenses Faculty-Required form to begin reimbursement process Request for Payment Attach original itemized receipts Resident Physician automated Attendance Leave Record Form UNR Form Resident Physician - Automated Leave File Separation Checklist All Employee Types Sexual Harassment Policy & Complaint Procedure All Employee Types Web Sexual Harassment Policy and Complaint Acknowledgment Form (Faculty) NSHE Policy Against Sexual Harassment and Complain Procedure, Nevada Workplace Safety and Policy Statement Alcohol/Drug Free Workplace are included Sexual Harassment Policy and Complaint Acknowledgment Form (Volunteers) Volunteers Stipends PDQ Instructions Instructions for completion of Academic Stipends form Student Employee Evaluation UNR Form: Student Employee Evaluation Student Employment Job Classifications Schedule STUDENT EMPLOYMENT JOB CLASSIFICATIONS COMPENSATION AND CLASS CODES Tenure Extension Request Form Used for faculty hired mid-year or for faculty who need to request an extension to their tenure clock. Enables tenure calendar to begin at the beginning of the first full year of employment or be extended for a specific period of time. Tenure Extension Clause Sample Terms of Employment for Adjunct/Clinical Faculty UNR Form: Clinical /Adjunct Faculty Terms of Employment for Faculty UNR Form: Faculty-Contract_Remarks_TermsofEmployment Terms of Employment for Graduate Assistants UNR Form: Graduate Assistant Terms of Employment for LOAs and Overloads UNR Form: LOAs and OVLs Terms of Employment for Post Docs UNR Form: Post Docs-Contract_Remarks_TermsofEmployment Terms of Employment for Resident/Physician UNR Form: Resident/Physician-Contract_Remarks_TermsofEmployment Time Sheet (Pay-Period)-Student Employment UNR Form: Student Employment Time Sheet for signature authority per pay- period Work Study Dates UNR Form: Work Study Dates and Earning Codes

Form title Description 2008 Payroll/HR Cutoff Schedule 2008 Cut-off Schedule 2008 Time Sheet Cut-off Dates Dates in which paperwork is due in order for the employee's check to be included within the next pay date. 2009 Batch Entry Cut-off 2009 Cut-off Schedule 2009 Classified Staff automated Attendance Leave Record Form Classified- This automated leave file is for classified leave keeping only and will not work for faculty leave records. 2009 Payroll/HR Cutoff Schedule 2009 Cut-off Schedule 2009 Time Sheet Cut-off Dates Dates in which paperwork is due in order for the employee's check to be included within the next pay date. Accelerate Salary Request RAS-1 - Classified: Form used to request higher pay for potential employees. Activity Release Use when conducting a field trip with students. The waiver should be specific to the activity. Legal counsel should be consulted for waiver language and requirements. Affidavit of Rejection of Coverage for Corporate Owner/Officer or Manager of an LLC. Use when an officer of a quasi-public or non-profit corporation, or an officer who is an owner of a private corporation or a manager of a limited liability company has rejected workers' compensation coverage. Affidavit of Rejection of Coverage for Corporate Owners/Officer or Manager of an LLC Use when an officer of a quasi-public or non-profit corporation, or an officer who is an owner of a private corporation or a manager of a limited liability company has rejected workers' compensation coverage Affidavit of Rejection of Coverage for Individual/Sole Proprietor Use when an individual or sole proprietor has rejected workers' compensation coverage Affidavit of Rejection of Coverage for Workers' Compensation - Individual/Sole Proprietor Use when an individual or sole proprietor has rejected workers' compensation coverage. Agreement for Salary Reduction Under Section 403(b) Voluntary Tax Sheltered Annuity 403(b) Deduction and Change Form. Alcohol/Drug Test Consent Form TS-76 - Classified - State of Nevada form Application for Reimbursement of Claim-Related Travel Expenses D-6 - Used by employee to receive compensation when missing more than 5 days from work in a 20 day period Application for Reimbursement of Claim-Related Travel Expenses D-26 - Can be used when requesting reimbursement for travel Benefits Enrollment and Change Form BECF - Please contact the Benefits Office to obtain a form at 784-6845. CAT Leave - Authorization to Release Employee Name for Catastrophic Leave CAT-3 - Classified employees complete this form so that his/her name can be released to solicit leave donations and/or to employees that receive leave donations. CAT Leave - Formal Appeal to Committee on Catastrophic Leave PAY-23B - Classified employees may file an appeal if "aggrieved" by any decision of an appointing authority made pursuant to NRS 284.362 to 284.3626, may appeal the decision by filing a written notice with the Committee on Catastrophic Leave within 10 days after the date of the decision. CAT Leave - Physician's Certification for Catastrophic Leave Request PAY-23C - Classified employees use this form to have a Physician certify the medical condition for catastrophic leave eligibility. CAT Leave - Request to Receive Catastrophic Leave Donations Form CAT-1 - Classified employees use this form to request to receive Catastrophic Leave donations. UNR Catastrophic Leave - General Procedures document. CAT Leave - Request to Transfer Catastrophic Leave Form CAT-2 - Classified employees complete this form to donate sick and annual leave to an eligible employee or to the catastrophic leave pool Claim Against The State of Nevada Use to file a tort claim against the State of Nevada for an incident or accident in which a NSHE employee or agency has caused injury or damages to another party due to a wrongful or negligent act. Classified Compliance Form Classified-UNR/NSHE only. Classified Grant-in-Aid VPAF 103 - For tuition payment for classified employees. For more information on filling out the form, call (775) 784-6082. Crime and Fidelity Loss Report URM-013 - Use when there is a discovery of a financial loss or a situation that might result in a financial loss from employee dishonesty; forgery or alteration; theft, disappearance or destruction; and computer fraud Dental Claim Form For dental claim reimbursement Designation of Beneficiary for Unpaid Compensation Form This form allows employees to designate one or more beneficiaries to receive the amount of any unpaid compensation in the event of the employee's death. Direct Deposit Faculty/Classified - Please include a voided check with this request. Deliver to Payroll at MS/ 122 or hand deliver to Ross Hall, Room 111. Employee Appraisal NPD-15 - Classified State of Nevada appraisal/performance evaluation. Employee Appraisal-Instructions Classified State of Nevada Employee appraisal/performance evaluation instructions. Employee Appraisal-More Job Elements NPD-15 - Classified State of Nevada employee appraisal/performance evaluation additional job elements. Employee Appraisal-Rating Job Elements Classified State of Nevada employee appraisal/performance evaluation job elements. Employee Breath Test for Alcohol TS-69 - Classified-State of NV form Employee Notification Sheet Classified/Faculty - All new international employees must fill out this form. For more information go to Non-Resident Alien Manual Employment Application NPD-1 - Classified Employment Requisition VPAF 202 - Classified (New Positions/Reclasses/Recruitments) Faculty Grant-in-Aid UNR For payment of a specified portion of the registration fee for faculty and eligible dependents. For more information on filling out the form, call (775) 784-6082. FARP FICA Alternative Retirement Plan. This plan was established for NSHE employees who do not participate in another retirement plan NSHE and who or would contribute to FICA tax. FICA Alternative Plan Information Sheet Description of FICA Alternative Retirement Plan for Classified Temporary Casual and Letter of Appointment Employees FICA Alternative Withdrawal Rules for Withdrawal from FICA Alternative Plan for Classified Temporary Casual and Letter of Appointment Employees FICA Enrollment Form (Continuing Employees) Federal Insurance Contributions Act. NSHE implemented an alternative plan for continuing employees administered by the State's Deferred Compensation Committee for employees who would typically contribute to the FICA portion of Social Security. FICA Enrollment Form for (Newly Hired Employees) Federal Insurance Contributions Act. NSHE implemented an alternative plan for continuing employees administered by the State's Deferred Compensation Committee for employees who would typically contribute to the FICA portion of Social Security. FICA Enrollment Form-Continuing Employee with SSA-1945 form attached FICA Alternative Form for continuing Classified Temporary Casual and Faculty Employees FICA Enrollment Form-New Hire with SSA-1945 form attached Used by departments for hiring new Classified Temporary Casual and Faculty Employees Fine Arts Exhibit Coverage Request URM-014 - Use to report fine art loaned to the university or college. Fine Arts Loan Agreement URM-10 - Artwork Lending Agreement to use between the university or college and Lender. Formal Appeal NPD-54 - Classified - State of Nevada form Formal Grievance NPD-50-A - Classified-State of NV form Global Companion/MEDEX Use this card when traveling out of country. It provides insurance information for foreign voluntary workers' compensation coverage. Grievance Filing (Agreement to Extend) TS-145 - Classified-State of NV form Grievance Procedure Classified-State of NV form Hartford Deferred Compensation 457 Change Form Voluntary Deferred Compensation 457 Change Form for Hartford Insurance Company Hourly and Overtime PR-29 - This form is used for classified, technical, or hourly paid employees, including overtime. It also contains a daily log for department wishing to maintain a daily record of hours worked. ING Deferred Compensation 457 Change Form Voluntary Deferred Compensation 457 Change Form for ING Life Insurance and Annuity Company Leave Choice Option Form Used to choose leave option when an employee is eligible for temporary total disability (TTD) benefits Life Insurance Beneficiary Form The Standard Insurance Company provides life insurance for all employees covered by PEBP Benefits. Complete this form to update your beneficiary for this benefit. LWOP Classified Payroll Correction Form VPAF 203 - Classified Leave Without Pay Medical Claim Form For state self-funded medical and vision plan claims reimbursement Medical Resident / Postdoctoral Fellow Company Allocation Form Retirement Plan Enrollment and Change Form. Metlaw Enrollment Form Enrollment form for the Metlaw Legal Plan by Hyatt Nepotism Classified Notice of Injury or Occupational Disease Incident Report C-1 - Completed by employee when an injury or occupational disease occurs. Must be submitted within 7 days of the incident. Notice of Internal investigation NPD-32 - Classified - State of Nevada form PERS Change of Member Contribution Plan For a PERS member who is changing from the employee/ employer contribution plan to the employer-pay contribution plan. PERS Member Enrollment Form This form should be completed for all new hires that are eligible for enrollment under NRS 286.293. This form is also used to enroll persons who have returned from leave without pay or from ineligible status, or for a retired employee electing to re-enroll under authority of AB 555. PERS Survivor Beneficiary Designation This form should be completed for the designation of a beneficiary once the member has established eligibility for survivor benefits. Phase-In Retirement Application (RPA Plan) Faculty Retirement Plan (not PERS) PERS members should contact PERS for a Phase-In Retirement Application Position Questionnaire NPD-19 - Classified (New Positions/Reclasses) Position Questionnaire - Instructional NPD-19 Instructions - Classified (New Positions/Reclasses) Potential Liability Incident Report URM-001 - Use when an incident occurs that might result in liability on the part of the NSHE. Property Change Reporting Form URM-008 - Use to add or delete a building from the NSHE building inventory. Property Loss Report URM-003 - Use for theft or damage to NSHE property that exceeds $2,000 (Excluding Motor Vehicles) and for reporting boiler and machinery losses that exceed $2,000. Report form for Suspected Alcohol/Drug Impairment TS-77 - Classified-State of NV form Request for Change in Payroll PR-45 - Request to change payroll charges from one account to another account. Response to Formal Grievance (See Grievance Procedure below) NPD-51 - Classified-State of NV form RPA Allocation Form Faculty Retirement Plan Enrollment and Change Form. Section 125 Direct Deposit Form - ASI Speed up the receipt of your Section 125 reimbursement with Direct Deposit.  Have it paid directly into your bank account. Section 125 Request for Additional Debit Card - ASI Need a debit card for your Spouse or Dependents?  Complete this form and fax it to ASI. Section 125 Request for Reimbursement - ASI This form is for reimbursement of eligible expenses from the Health Care and Dependent Care Programs under Section 125 Sexual Harassment Policy and Complaint Acknowledgment Form (Classified and Temporary Classified Employees) Classified Specificity of Charges NPD-41 - Classified-State of NV form SSA-1945 Windfall Elimination Provision Explanation and Statement concerning Employment in a job that is not covered by Social Security. Used for Classified and Faculty Employees. Stop Payment Stop payment form for a BCN Payroll check. Supervisor Training Responsibilities for Student Employees Supervisor's Guide to Prohibitions and Penalties Used for Classified Employees Temporary Adjustment to Salary Request Classified Temporary Position Request PS300 - Classified (Procedures below) Temporary Position Request Procedures Classified (PS300 Instructions) Variable Workweek Request Classified Vehicle Accident Report URM-002 - Use when a motor vehicle accident occurs involving a third-party, whether or not there is damage or injury. Vehicle Change Reporting Form URM-004 - Use to add or delete a vehicle from the NSHE vehicle inventory. Also use to add or delete insurance coverage. Volunteer Agreement Used when a volunteer Category "B" volunteer is engaged: A category "B" volunteer is a person who performs a volunteer assignment for more than three days or on a recurring basis. W-4 IRS Federal Tax withholding form. W-5 IRS Federal Tax withholding form. Whistle Blower NPD-53 - Classified-State of NV form Windshield Loss Report URM-007 - Use this report when there is a windshield/auto glass loss. Work Performance Standards NPD-14 - Classified-State of NV Work Performance Standards-Development Instructions Classified-State of NV Work Performance Standards-More Job Elements Classified-State of NV Workers' Compensation Waiver Flowchart and Excluded Employees Summary Use this chart as a guideline to determine when Workers' Compensation coverage is required or when it can be waived. Written Reprimand NPD-52 - Classified-State of NV form