HR Forms
Open Enrollment for 2024 benefits begins Monday, October 23, 2023, and continues through Wednesday, November 8, 2023, with benefit elections taking effect January 1, 2024. Stay tuned for our ‘Explore Your Benefits’ mailer that will be mailed in the fall. Note: new or continued health care and/or dependent care FSAs, must be elected during open enrollment each year.
Waiver Form (Effective March 22, 2018)
Benefits
- Affidavit of a Qualifying Adult (PDF- must download to electronically sign)
- Anthem Major Medical Claim Form (PDF)
- Optum Reimbursement Instructions & Claims Form (PDF)
- Health Information Authorization (DOC)
- University of Louisville 457(b) Fidelity Account Application (PDF)
- University of Louisville 457(b) Salary Reduction Authorization Form(DOC)
- University of Louisville 457(b) TIAA Account Application (PDF)
- Voluntary Benefit Cancellation Form(DOC)
Tuition Remission Forms
Compensation
- Postdoctoral Position Approval Form
- Job Description Template & Instructions
- Additional Pay Form
- Cellular/Mobile Device Stipend Request Form (For PDF instructions, click here)
Employee Relations
- Americans with Disabilities Act Accommodation (DOC)
- Discriminatory Conduct Complaint Form
- Performance Evaluation Form
- Performance Employee Self-Assessment Form
- Grievance Form (PDF)
- Exit Surveys
Employment Services
Leave Forms
Continuous or intermittent leave for self:
- Family & Medical Leave Request Guidance
- Employee Request for Family Medical Leave - Employee's Serious Health Condition
- Employee Request for Family Medical Leave - Birth, Adoption or Placement of a Child
- Employee Request for Temporary Medical Disability Leave (Used when FMLA is exhausted or unavailable)
- Administrator Request for Family Medical Leave (Administrators Only - Submit to Office of the President of Provost as appropriate)
Continuous or intermittent leave to care for someone else:
- Family & Medical Leave Request Guidance
- Employee Request for Family Medical Leave - Family Member's Serious Health Condition
- Employee Request for Family Medical Leave - Ill/Injured Servicemember
- Employee Request for Family Medical Leave - Ill/Injured Veteran
- Employee Request for Family Medical Leave - Qualifying Exigency For Military Family Leave