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. |
|
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 | Enroll, change or terminate coverage for you and/or your dependents. |
| HMO | |
| PPO | |
| 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 Prescription Mail Service | |
| HIRD Form 2013 | |
| 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. |
| 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 | |
| Position Request Form | Please contact HR to discuss updated approval process . |
| Reclassification Form | Form to request review of administrative role document. |
| Search Plan Form | Documents search committee membership and outreach. To be completed after financial approval has occurred. |
| 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.
