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 (Fillable PDF)
• First Fill Letter

Advanced Leave Agreement (Fillable PDF)

Authorization Form for Release of Medical Information (Fillable PDF)

Background Check Consent Form  link to EEO forms on line

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

Clothing Policy Forms

• Taxability Determination Form (Fillable PDF)
• 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 (Fillable PDF)

Deferred Compensation Plan Participation Agreement (Fillable PDF)

Direct Deposit (EFT) Authorization Form

Donor Leave Request Form (Fillable PDF)

Employee Information Form (<a( a="" href="/dotAsset/223272.pdf">Fillable PDF)

Employment Summary (Word)

Extra Duty Compensation Form (Excel) (Fillable PDF)

Fair Labor Standards Act (FLSA) Forms

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

Family and Medical Leave (FMLA) Forms

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

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

Funeral Leave Request Form (Fillable PDF)

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)
• GHI Health Savings Account (HSA) Enrollment & Change Form (PDF)

Holiday Overtime Reporting (Fillable PDF)

I-9 Form (Fillable PDF)

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

K-4 - Kansas Income Tax Withholding (Fillable PDF)

KanElect Flexible Spending Forms

• KanElect Flexible Spending Enrollment/Change form (PDF)
• KanElect Flexible Spending Claim Form (Fillable PDF) (Word)
• KanElect FSA Debit Card Application Form

KPERS

• KPERS Name Change Form (Fillable PDF)
• KPERS Report of Member Status (Fillable PDF)
• KPERS Beneficiary Form - KPERS Retirement Plan (Fillable PDF)

Learning Quest Payroll Deduction Forms

Life Insurance Beneficiary Form - Regents Retirement Plan (Fillable PDF)

Nine Pay Twelve Salary Payment Option (Fillable PDF)

Oath of the State of Kansas

Oath of the State of Kansas - Student Employees

Overtime Approval Form (Fillable PDF)

Phased Retirement Sample Agreement (Fillable 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 (PDF)

PSU ID Worksheet (Fillable PDF)

Retirement Plan Investment Agreement - Regents Mandatory Retirement Plan (Fillable PDF)

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - Pre Tax (Fillable PDF)

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - After Tax Roth (Fillable PDF)

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

• Leave Request Form (Fillable PDF)
• Donation Form (Fillable PDF)
• Health Care Provider Statement (Word)

Shared Leave - KNEA Program

• Leave Request Form (Fillable PDF)
• Donation Form (Fillable PDF)
• Health Care Provider Statement (Word)

Social Security Exemption Notification

State of Kansas Tax Clearance Program Employee Acknowledgement

Statement of Substantial Interest 2012 (Fillable PDF)

Substance Abuse Policy Affirmation Form

Substantial Presence Worksheet - 2013

Temporary Classified Position Acknowledgment

Timesheet (Fillable PDF)

Tuition Assistance Applications

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

Volunteer Agreement and Release (Fillable PDF)

W-4 - Federal Income Tax Withholding (Fillable PDF)

Withdrawals from the Kansas Board of Regents Mandatory Retirement Plan

Withdrawals from the Kansas Board of Regents Voluntary Retirement Plan