Accident/Injury
- Employee On-the-Job Accident and Injury Report - Procedures
- Workers’ Compensation Information: What You Need to Know
- Estimated Physical Capabilities
- Non-Employee Accident or Injury Report
Affirmative Action Forms
- Request for Reasonable Accommodation Regarding COVID-19 Facial Coverings
- Request for Reasonable Accommodation
- Request for Sign Language Interpreter (Contact HR for more information)
Appointments
APPOINTMENT GUIDE
- Appointment Form
- Consulting Application
- Outside Employment Form
- Prior Service Request
- UP-211 Form: Reemployment of Retired Public Employees
- The Form I-9 (INS Employment Eligibility Verification) - more information
- Volunteer Form
Benefits & Retirement
RETIREMENT@WORK
- Retirement Program Election Form
- Blue Choice Turning 65 Form (Medicare Secondary)
- CSEA Employee Benefit Fund Application (Dental/Vision)
- CSEA Membership Application
- UUP Benefit Forms (Dental/Vision/Life/Address/Membership/Student Verification/others)
- Employees Retirement System Forms
- MVP Turning 65 Form (Medicare Secondary)
- Opt Out Program (health insurance)
- Phased Retirement Program for Academic Employees Application
- Retirement Form Letter
- NYS Health Insurance Transaction Form (PS-404)
- NYS Health Insurance Transaction Form For Graduate and Teaching Assistants ONLY
DENTAL AND VISION
TUITION ASSISTANCE
Directory
- Address/Name Change Form (online submission, must have NetID - same as email)
- Campus Address or Phone Update
- Department Name Recommendation Form
Extra Service
- Extra Service Matrix Of Forms For Required Payment
- Dual Employment Approval Form (Other Agency)
- UP-8 (Full-time UUP)
- Extra Service Request On-Line Form
- UP-6 Request for Extra Service Approval for M/C Employee (Other Agency)
Evaluation/Performance Program
CSEA EMPLOYEES
PEF EMPLOYEES
SECURITY SERVICES UNIT (NYSCOPBA) EMPLOYEES
UNIVERSITY POLICE OFFICERS (PBA OF NYS)
- University Police Officer 1- Performance Evaluation
- University Police Officer 2- Performance Evaluation
MANAGEMENT CONFIDENTIAL EMPLOYEES
PROFESSIONAL (UUP) EMPLOYEES
Incident Reporting
Leaves
SEE FULL LISTING OF LEAVES
- Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave
- Certification of Health Care Provider for Employee’s Serious Health Condition
- Certification of Health Care Provider for Family Member’s Serious Health Condition
- Certification of Qualifying Exigency for Military Family Leave
- Leave Request Form
- Return to Work Authorization Form
- Paid Family Medical Leave
Miscellaneous
- Acronyms
- Adele Catlin Award Nomination Form
- Alternative Work Location Form - for Winter Shutdown
- BizLibrary Log In
- Chancellor’s Award for Excellence in Classified Service Guidelines and Nomination Form
- Employee Assistance Program
- Green & Gold Star Award Nomination
- LENS Request Form - Verification of Driver’s License
- Outstanding Service Award Nomination Form and Checklist
- Separation Checklist — Employee and Supervisor must complete upon separation from employment
- Trainings
- Union Contracts
Payroll Forms
- Attendance Guidelines
- Direct Deposit Form (pdf)
- Leave Donation Form (pdf)
- Online Time & Attendance
- Payroll Calendars
- Reactivation Request Form
- Salary Schedules
- Savings Bonds - AC-3245 Treasury Direct Deposit Transactions
- Time Sheets
WITHHOLDING
- IT-2104(NYS) Employee’s Withholding Allowance Certificate
- IT-2104E(NYS) Certificate of Exemption From Withholding
- W-4 (Federal) Employees Withholding Allowance Certificate
Probation (Classified Employees Only)
For more information, please contact Kallee Quill at kequill@brockport.edu