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.

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
Employment Application General Employment Application
Hiring Guidelines for Administrative Staff  
Role Document Form to describe an administrative role (in Word)
Classification Form Form to request review of administrative role document (in Word)
Classification/Budget Form Form to request a salary increase as part of a reclassification (in Word)
Hiring Guidelines for Casual Wage Employees  
Casual Wage/Limited Term Form Form for hiring casual wage or temporary administrative staff (in Word)
Transition Request Form Form for using vacancy dollars for temporary administrative staffing needs (in Word)
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
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  
Role Document Form to describe an administrative role (Word document for editing)
Introductory Period Evaluation To be completed by supervisors and administrative staff employees after 90 days of employment (Word document for editing)
Goal Setting/Performance Planning Form Used by supervisors and employees to set goals (Word document for editing)
Interim Goal Review/ Update Form Used by supervisors and employees to document goals throughout the year (Word document for editing)
Performance Review/ Assessment Form Used by supervisors and employees to document the achievement of goals and overall performance (Word document for editing)
Guidelines for Assessing Yourself 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

 

 

HR values and respects confidentiality.