Accident Report Forms

• Employer's Report of Accident (Required Browser - Google Chrome): State Self Insurance Report of Incident
• PSU Incident Report
• First Fill Letter

Acknowledgement and Agreement

Advanced Leave Agreement (Fillable PDF)

Affordable Care Act (ACA) - New Health Insurance Marketplace Coverage Options & Your Health Coverage

Authorization Form for Release of Medical Information (Fillable PDF)

Background Check Acknowledgement and Authorization 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

Compensatory Time Agreement for Non-Exempt Employees

Conflict Resolution/Grievance Review Request Form (Fillable PDF)

Direct Deposit (EFT) Authorization Form

Donor Leave Request Form (Fillable PDF)

Employee Information Sheet

Employment Summary (Word)

Extra Duty Compensation Form 

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 - Enrollment is done online in the SEHP Membership Administration Portal
• GHI Change Form - contact HRS regarding changes

Holiday Overtime Reporting (Fillable PDF)

I-9 Form

Independent Contractor / Consultant Certification & Request to Pay Worksheet

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

KPERS

• KPERS Name Change Form (Fillable PDF)
• KPERS Report of Member Status (Fillable PDF)
• KPERS Beneficiary Form - KPERS Retirement Plan (Fillable PDF)
• KPERS No Prearranged Employment Form (Fillable PDF)

Learning Quest Payroll Deduction Forms

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

Life Insurance - Conversion Option (Fillable PDF)

Life Insurance - Portability Option (Fillable PDF)

Nine Pay Twelve Salary Payment Option

Oath of the State of Kansas

Oath of the State of Kansas - Student Employees

Overtime Approval Form (Fillable PDF)

Phased Retirement Sample Agreement (PDF)    (Word)

Performance Management Counseling Checklist

Performance Review Process

• University Support Staff and Unclassified Performance Review Form

Position Descriptions

• University Support Staff and Unclassified
  
  • Position Description Form (Word)
  • Position Review Request Form

PSU Foundation Payroll Deduction Form (PDF)

PSU ID Worksheet

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)

Retirement Verification

Shared Leave State of Kansas Program (University Support Staff 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
• Health Care Provider Statement (Word)

Social Security Exemption Notification

Standard Evaluation Form of Applications

State of Kansas Tax Clearance Program Employee Acknowledgement

Substance Abuse Policy Affirmation Form

Substantial Presence Worksheet - 2019

Temporary University Support Staff Position Acknowledgment

Time Sheets

• Hourly Employee - No Benefits 
• Employee with Benefits

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