Forms On-Line

HRS Forms On-Line

The following are forms that are available for download from this site. You must have Adobe Acrobat Reader 3.0 in order to use these forms.

To read the documents marked PDF requires "Adobe Acrobat". On campus users can contact #4600 for assistance.

NOTE: These forms are available for PSU Employees only

The forms below are available directly on-line either as an HTML file, or for download into Adobe Acrobat Reader 3.0. 

Accident Report Forms

• Employer's Report of Accident (PDF) (Word Doc) 
• PSU Incident Report (PDF) (Word Doc)
• First Fill Letter

Advanced Leave Agreement

Authorization Form for Release of Medical Information

Background Check Consent Form  link to EEO forms on line

Change Checklist (Changes in Name, Address, Marital Status & Number of Children) ) (Word) (PDF)

Clothing Policy Forms

• Taxability Determination Form (PDF) (Word)
• Department Business Attire Item Policy - Template (WORD)
• Department Business Attire Item Policy - Sample (WORD)

Compensatory Time Agreement for Non-Exempt Employees

Conflict Resolution/Grievance Review Request Form

Credit Card Application - VISA BTC

Deferred Compensation Plan Participation Agreement

Direct Deposit (EFT) Authorization Form

Donor Leave Request Form

Employee Information Form (Word) (PDF) (Fillable PDF)

Employment Summary

Extra Duty Compensation Form (Excel) (PDF)

Fair Labor Standards Act (FLSA) Forms

• FLSA Questionnaire (Word) (PDF)
• FLSA Compliance Checklists:
• -- Executive Exemption
• -- Administrative Exemption
• -- Professional Exemption
• -- Computer Exemption

Family and Medical Leave (FMLA) Forms

• FMLA Leave Request Form (Word) (PDF)
• Certification of Health Care Provider for Employee
• Certification of Health Care Provider for Family Member
• Certification of Qualifying Exigency for Military Family Leave
• Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave

Funeral Leave Request Form (KAPE Service & Maintenance Employees ONLY)

Funeral Leave Request Form

Group Health Insurance (GHI) Forms

• GHI Enrollment Form (PDF)
• GHI Change Form (PDF)
• GHI Communication Form (PDF)
• GHI Dependent Grandchild Affidavit (PDF)
• GHI Request for Enrollment of Common Law Spouse (PDF)

Holiday Overtime Reporting

I-9 Form

Independent Contractor / Consultant Certification & Request to Pay Worksheet (Word) (PDF)

K-4 - Kansas Income Tax Withholding

KanElect Flexible Spending Forms

• KanElect Flexible Spending Enrollment/Change form (PDF)
• KanElect Flexible Spending Claim Form (PDF) (Word)
• KanElect FSA Debit Card Application Form
• KanElect Flexible Spending Direct Deposit Authorization
• KanElect Flexible Spending E-Mail Notification Authorization

KPERS

• KPERS Name Change Form
• KPERS Report of Member Status
• KPERS Beneficiary Form - KPERS Retirement Plan

Learning Quest Payroll Deduction Forms

Life Insurance Beneficiary Form - Regents Retirement Plan

Nine Pay Twelve Salary Payment Option (Word) (PDF)

Oath of the State of Kansas

Oath of the State of Kansas - Student Employees

Overtime Approval Form

Phased Retirement Sample Agreement (PDF) (Word)

Performance Management Process

• Classified Employee Process
• Unclassified Administrative and Professional Staff (non-teaching)
  • Goals & Objectives Form
  • Performance Factors

Position Descriptions

• Classified
  • Position Description Form (PDF) (Word)
  • Position Review Request Form
• Unclassified
  • Position Description Form (PDF) (Word)
  • Temporary Faculty (Lecturer or Instructor) Position Description Template (Word)

PSU Foundation Payroll Deduction Form

PSU ID Worksheet (Word) (PDF) (Fillable PDF)

Retirement Plan Investment Agreement - Regents Mandatory Retirement Plan

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - Pre Tax

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - After Tax Roth

Shared Leave State of Kansas Program (Classified and Non-KNEA Members)

• Leave Request Form
• Donation Form
• Health Care Provider Statement

Shared Leave - KNEA Program

• Leave Request Form
• Donation Form
• Health Care Provider Statement

Social Security Exemption Notification

State of Kansas Statement of Substanial Interest

• Notice (PDF)
• Form (PDF)

State of Kansas Tax Clearance Program Employee Acknowledgement

Statement of Substantial Interest 2010

Substance Abuse Policy Affirmation Form

Substantial Presence Worksheet - 2011

Substantial Presence Worksheet - 2012

Temporary Classified Position Acknowledgment

Timesheet (Word) (PDF) (Fillable PDF)

Tuition Assistance Applications

• Employee (non-Faculty) Tuition Assistance
• Faculty Fee Waiver Form
• Dependent Child(children) Tuition Waiver
• Spouse Tuition Assistance Application
• FERPA Release
• Tuition Tax Status

W-4 - Federal Income Tax Withholding

Withdrawals from the Kansas Board of Regents Mandatory Retirement Plan

Withdrawals from the Kansas Board of Regents Voluntary Retirement Plan