Forms

Benefits

Form Name (click to download) Description
Change of Address Use to manually update your address in Banner and with vendors; return to HR.
Change of Beneficiary Update your beneficiary information for your College sponsored life insurance; return to HR.
Life Insurance Enroll in coverage
TIAA-CREF (Retirement Plans) Return form to TIAA-CREF.
Delta Dental Enrollment Enroll, change or terminate coverage for you and/or your dependents.

EyeMed Enrollment Form

EyeMed Out of Network Claim Form

Enrollment Application

Claim to visit a provider that is not a participating provider on the EyeMed network

Flexible Spending Accounts Enrollment These accounts allow you to set aside up to $5,000 pre-tax earnings to pay for qualified medical and/or dependent care expenses.
Medical Care Reimbursement For reimbursement of qualified medical expenses.
Dependent Care Reimbursement For reimbursement of qualified dependent expenses.
Crosby Direct Deposit Authorization Sign up to have reimbursements directly deposited to your bank account.

Harvard Pilgrim Health Care Enrollment HMO

Enroll, change or terminate coverage for you and/or your dependents.

Enroll, change or terminate coverage for you and/or your dependents. 

Harvard Pilgrim Health Care Fitness Reimbursement

Get reimbursed for up to $150 per calendar year for qualifying fitness expenses; return to HPHC.
Harvard Pilgrim Health Care Weight Loss Reimbursement  
Harvard Pilgrim Health Care Prescription Mail Service  
Leaves of Absence Employees may request up to 12 weeks of unpaid leave in a 12-month period. For more information on Leaves of Absence, refer to the Administrative Handbook .
Employee Serious Health Condition - Faculty/Staff Medical leave application form for Faculty and Staff.
Employee Serious Health Condition - Union Medical leave application form for Union.
Maternity Leave - Admin, Faculty & Union Maternity leave application form for all employees.
Serious Health Condition of Family Member or Parental Leave Non-Maternity medical leave form - all employees.
Unpaid Personal Leave

Non-Medical leave of absence. The granting of an unpaid leave of absence is at the sole discretion of the College.

Long Term Disability Application

Faculty Administrative Staff please.

Life Insurance Enrollment/Change To enroll/change life insurance amounts.
Life Insurance Conversion/Portability Notice 

Convert Group insurance to an Individual policy - maintain coverage after leaving job or reaching a certain age

Port Group insurance to a Group term policy - maintain coverageafter leaving job

Life Insurance - Medical History Statement (Evidence of Insurability)

Complete if needed; to request additional life insurance; see HR for more information.

Salary Reduction Agreement for TDA To start/change your pre-tax contributions to the Tax Deferred Annuity; return to HR.

 

Employment

Form Name (click to download) Description
Casual Wage / Limited Term Application for hiring temporary administrative staff.
Employment Application General Employment Application
Hiring Guidelines for Administrative Staff Under Construction
Position Request Form Please contact HR to discuss updated approval process .
Reclassification Form Form to request review of administrative role document.
Search Plan Form Please contact HR to discuss updated online search plan form.
Hiring Guidelines for Faculty  
Search Plan Part I Documents search committee membership and outreach.
Search Plan Part II Documents short list of candidates.
Search Plan Part III Documents final candidate identified.
Transition Request Form to use vacancy dollars for temporary administrative staffing needs.
Tuition Assistance - Union Application for requesting tuition reimbursement for Union members.
Tuition Reimbursement - Staff Application for requesting tuition reimbursement for Staff members.
Tuition Remission at Wellesley College Application for eligible employees with dependent daughters attending Wellesley College.
Workers Compensation Form to complete with any work place injury.

 

Performance Management

Form Name (click to download) Description
Staff  
Introductory Period Evaluation To be completed by managers after administrative hire has completed 90 days of employment.
Stage I: Goal Setting/Performance Planning Goal Setting word document
Stage II: Interim Goal Review Used to document mid year assessment of stated goals.
Stage III: Performance Review and Assessment Documents achievement of goals and overall performance.
Self Assessment Tool Used by supervisors and employees to think about individual performance.
Union  
30-day Evaluation  
60-day Evaluation  
90-day Evaluation  
Performance Management Documents performance on an annual basis.
Role Document Form to describe administrative roles.

 

 

HR values and respects confidentiality.

Of Interest

 

all one

mywellesley

  

Leadership Program
 

illuminator

 

Contact Us

Human Resources Office

Green Hall, Room 136
Wellesley College
106 Central Street
Wellesley, MA 02481

Phone: 781.283.3202
Fax: 781.283.3663
working@wellesley.edu