HR Forms

• Benefits Forms
  • 01. Medical

    Aetna Enrollment and Change Request Form - for Choice POS II Plan

    Aetna Enrollment and Change Request Form - for the HMO Plan

    Aetna Medical Claims Request Form 

    UnitedHealthcare Plan Enrollment Application and Change Form - for Select Plus POS Plan

    United Healthcare Out-of-Network Claim Form - for PPO and Select Plus POS Plans

    United Healthcare Overseas Claim Form

    Prescription Drug Claim Form - Medco Health Direct Reimbursement

    Prescription Mail Order Form - Medco by Mail

    VSP Claim Form
  • 02. Dental

    Aetna Dental Enrollment/Change Form

    Aetna Dental Claim Form and Instructions

    MetLife Dental Claim Form and Instructions
  • 03. Domestic Partnership

    Statement of Domestic Partnership

    Statement of Termination of Domestic Partnership

    Tax Certification of Dependency for Health Insurance Coverage
  • 04. Flexible Expense and Transit Reimbursement Accounts

    PayFlex Expense Account Forms - for expenses incurred beginning January 1, 2011

    PayFlex Expense Account Claim File Instructions

    PayFlex Health Care (Medical) Claim Form 

    PayFlex Dependent Care Claim Form 

    PayFlex Expense Account Direct Deposit Authorization Form 

    PayFlex Parking Reimbursement Form 

    PayFlex Transit Reimbursement Form 

    PayFlex Letter of Medical Necessity Form 

    PayFlex Authorization to Release Personal Information Form

    Parking and Transit Reimbursement Account Add/Change/Termination Form
     
  • 05. Employee Child Care Assistance Program

    ECCAP Reimbursement Form

    DCEA (Dependent Care Expense Account) Reimbursement Form
  • 06. NJ Paid Family Leave Insurance

    New Jersey Family Leave Insurance - Application for Benefits - from the NJ State Division of Temporary Disability Insurance

    New Jersey Family Leave Insurance Plan Information
  • 07. Life Insurance

    Evidence of Insurability (EOI)

    Life Insurance Beneficiary Designation Change Form

    Prudential Application for Conversion of Group Life Insurance
     - (Brochure and Rates)
  • 08. Educational Assistance

    Staff Educational Assistance Application for Course Approval & Reimbursement

    Tuition Grant Application Academic Year 2012-2013 
  • 09. Retirement Plan

    TIAA-CREF Retirement Plan Forms

    Enroll or make a change online at TIAA-CREF

    Princeton University Retirement Plan Enrollment/Change Form

    Retirement Savings Plan Enrollment Form

    Retirement Savings Plan Rollover Form

    Vanguard Retirement Plan Forms

    Enroll or make a change online at Vanguard

    Princeton University Retirement Enrollment/Change Form

    Princeton University Retirement Plan Asset Transfer Form

    Retirement Savings Plan Enrollment Form

    Retirement Savings Plan Asset Transfer Form

    Retirement Savings Plan Rollover Form

    Princeton Vendor Selection Forms

    Princeton University Retirement Plan Vendor Selection Form

    Princeton Retirement Savings Plan Salary Reduction Agreement

    Other

    Certification of Prior Employment for Waiver of Service
  • 10. Disability

    Short Term Disability Application and Medical Certificate
  • 11. Other

    Application for Family Medical Leave (FMLA) — to care for a family member's serious health condition, submit directly to the University's Office of Employee Health.

    Waiver of Service Requirement — certification of prior employment for vesting for the Princeton University Retirement Plan and/or enrollment into the Long Term Disability Plan
• Forms for Faculty and Staff
  • Forms

    Conflict of Interest and Conflict of Commitment — Annual Staff Disclosure Form

    Employee Referral Form

    HR Self Service — to update your name, marital, addresses, contact information, or emergency contacts

    I-9 Employment Eligibility Form

    Personal Data and Self-Identification Form — for use if you don't have access to HR Self Service or need to update your educational/degree data or your optional self identification information (military/veteran status, race/ethnicity, disability status)
• Forms for Managers
  • Hiring

    Employment Requisition - to post a job opening using "Jobs at Princeton"

    Essential Function Statement

    Personal Data and Identification Form - for new hires to complete

    Casual Hourly Form - to hire a temporary hourly employee

    Short-Term Professional - to hire an exempt, temporary, professional employee
  • Other

    Additional Pay Form

    CALM Balance Adjustment Request Worksheet

    Casual Hourly Form

    Job Documentation Questionnaire

    Leave of Absence Form

    Position Form

    Position Description Form

    Position Description - IT Supplement

    Salary/Job Change Form

    Staff Attendance Record

    Staff Performance Appraisal - Form A

    Staff Performance Appraisal - Form B

    Staff Performance Appraisal - Form C

    Short Term Professional Form

    Systems Access Forms - gain access to HR's administrative systems

    Termination/Retirement Form