---
title: "Employee Forms"
url: "/offices/human-resources/employee-forms"
type: page
date: 2026-05-20
updated: 2026-05-21
---

# Employee Forms

## Employee Forms

### Medical

- [Special Enrollment Form ](https://drive.google.com/file/d/1d10opaesuy-ssmwjEqfzm4weL2DlG89c/view?usp=sharing)
- [Dependent Handicapped Status Form](https://drive.google.com/file/d/1-RydWy_7cTPPWRtug0hHhWpwlov8v_rR/view?usp=sharing)
- [Rx Reimbursement Form](https://drive.google.com/file/d/1NI0VEmRllT67LtK3yPTK2C6kPeqT8eq8/view?usp=sharing)
- [Medical Reimbursement Form](https://drive.google.com/file/d/1oVs4KpBN0Ivdu8prtTQqq-O0Y_qx5WZ6/view?usp=sharing)
- [Vaccine Reimbursement Form](https://drive.google.com/file/d/1wxXXcfmwu_AClLvNfsrVheEDAq0s4LNF/view?usp=sharing)
- [Medical Appeal Form](https://drive.google.com/file/d/1EaWI1o-AoPfKUbS6h4j6noAxCn7LEryf/view?usp=sharing)
- [HIPAA Authorization Form](https://drive.google.com/file/d/1NLR4FltzP-ODRkjOXFVCIivGk_b4qEK2/view?usp=sharing)

### Dental

- [ID Card - How to print your ID ](https://drive.google.com/file/d/1En0iPYfYPkmRYj4CFPz1a4kTslo2sLeC/view?usp=sharing)
- [How to Switch Plans](https://drive.google.com/file/d/1bu5bzJshAZwo7OpBHba89n--nmGCMNtv/view?usp=sharing)
- [Claim Form](https://drive.google.com/file/d/1Pq_L8KiX_S674B32EInl1bbfJJeGcRjD/view?usp=sharing)

### Employee Assistance Program

- [Information & Login Instructions ](https://drive.google.com/file/d/1kZqegLHkOROmxiihUb3UwWRb9u5oBIZ_/view?usp=sharing)

### Human Resources Forms (general)

- [Administrator Probation Form](https://drive.google.com/file/d/1W2wLBv5p26Wg_-TlVevAt4S5uUrbcOmJ/view?usp=sharing)
- [Employee/Staff Probation Form](https://drive.google.com/file/d/1bBmAW780SQ1PSCEjDJSeCP0L7ZrsNjuc/view?usp=sharing)
- [Administrative Evaluation Form](https://drive.google.com/file/d/10PxW9bFw4pLJfepBHSxsMlq8RUF6_0PN/view?usp=sharing)
- [Exit Interview Questionnaire](https://drive.google.com/file/d/1vxcdzWQLC1XlVM3YQSWnYyTcgb3SftI3/view?usp=sharing)

### Life Insurance

- [Beneficiary Form](https://drive.google.com/file/d/1axdDZwVqwmG6SGoJOiv81sVihZtOqMKt/view?usp=sharing)

### Onboarding

- [Acknowledgment of NYC Safe Sick Leave & Harassment Discrimination Policy](https://drive.google.com/file/d/1RfkuFj_6ZKA7afLC7SMJu7zEH2CW75Gj/view?usp=sharing)
- [Change in Personnel Status](https://drive.google.com/file/d/1fQF8UuzN6oyX1dSkKTFv0dsNm1seqiIV/view)
- [Computer Center Policy](https://drive.google.com/file/d/1CEVlPi4MNptTYvdFBBSY4SUz6dCPCo0D/view?usp=sharing)
- [Conflict of Interest Form](https://drive.google.com/file/d/1p9VvPnmdhpjF5FmW21x3j1QwpfbyUxLE/view?usp=sharing)
- [Employee Reference Form](https://drive.google.com/file/d/1f4FrSd6XDCHEBjGEBzB3wqRgkGzbQpdN/view)
- [Employee Opt-Out of Paid Family Leave Benefits](https://drive.google.com/file/d/1NYageCW49ViaUzZzuTmz3UjKklU6gC8y/view?usp=sharing)
- [Employee Paid Safe and Sick Leave Policy](https://drive.google.com/file/d/1HpIUR3utB9J-WbuAtiOYxuQZXzndMomA/view?usp=sharing)
- **Employment Application**
    
    Document
    
    [Employment-Application.pdf](/sites/default/files/media/2026-05/Employment-Application.pdf) (226.24 KB)
- **Direct Deposit Form**
    
    Document
    
    [Direct-Deposit-Form.pdf](/sites/default/files/media/2026-05/Direct-Deposit-Form.pdf) (329.27 KB)
- [Employment Eligibility Verification (I-9 Form)](https://www.uscis.gov/sites/default/files/document/forms/i-9-paper-version.pdf)
- [Employee's Withholding Certificate (W-4)](https://www.irs.gov/pub/irs-pdf/fw4.pdf)
- **Mission Green Book and Acknowledgment**
    
    Document
    
    [Green\_Book\_2017.pdf](/sites/default/files/media/2026-05/Green_Book_2017.pdf) (12.86 MB)
- **Sterling Background Form**
    
    Document
    
    [Sterling-Background-Form.pdf](/sites/default/files/media/2026-05/Sterling-Background-Form.pdf) (1.14 MB)

### Vision

- [Out-of-network claim form](https://drive.google.com/file/d/18ozQSIeGWmxQasE1Pp-LDmvRrJgELvF0/view?usp=sharing)

### Tuition

- [Tuition Remission Form](https://drive.google.com/file/d/1PTftZt_W3rcWe15qFJJRVsczcn_rd__W/view?usp=sharing)

### TIAA

- **MU - Salary Reduction Agreement**
    
    Document
    
    [SALARY-REDUCTION-AGREEMENT.pdf](/sites/default/files/media/2026-05/SALARY-REDUCTION-AGREEMENT.pdf) (188.48 KB)

### Leaves

- [Short Term Disability - DBL Claim Form ](https://drive.google.com/file/d/10DRKPVP-JgRRUbvtMsdk4ZCScDNxb-qD/view?usp=sharing)
- [Family Medical Leave - Request Form](https://drive.google.com/file/d/1wgwsPqfPYQwySj0WIdFeZ519LJJknOmi/view?usp=sharing)
- [Family Medical Leave - WH-380 FML Certification for a Family Member ](https://drive.google.com/file/d/161RTXqT0h1tnI9L0g5dhegaBu2yeNKS7/view?usp=sharing)
- [New York Paid Family Leave Form](https://drive.google.com/file/d/1QUhCgDJc-0esGCKZKe0I0IFu1IRt9jcb/view?usp=sharing)
- [NYC Safe & Sick Leave Request Form ](https://drive.google.com/file/d/1RfkuFj_6ZKA7afLC7SMJu7zEH2CW75Gj/view?usp=sharing)

### 24HourFlex

- [Dependent Receipt ](https://drive.google.com/file/d/1XuyHXtLpjUmxDZCf4qCz1T70C7gItLAG/view?usp=sharing)
- [Transaction Dispute ](https://drive.google.com/file/d/1wh9GfCHVSnk-Eqk36yo0jQ_QFr5Jl2Rk/view?usp=sharing)
- [Over the Counter Form](https://drive.google.com/file/d/1fD-H-1Z9Uya1JnHAhtVdZjKwlUbxIDqh/view?usp=sharing)
- [How to submit a receipt](https://drive.google.com/file/d/1fQTJtFBpKVTd3XGe8L7cWQD54JNtDSfC/view?usp=sharing)
- [Letter of Necessity ](https://drive.google.com/file/d/1L1vJLSby1XQu7L5gTca9Qe5EEzSkgdlc/view?usp=sharing)
- [Check Reissue Request ](https://drive.google.com/file/d/1GYxYNsIAWeaJeUGuTW4W4KnouIP7tEIe/view?usp=sharing)

### Academic Credit Union

- [Information & Online Enrollment Instructions](https://drive.google.com/file/d/1xioetAkWG0np7WKvHKucKLOE5AQ-goOL/view?usp=sharing)
- **Direct Deposit Form**
    
    Document
    
    [Direct-Deposit-Form.pdf](/sites/default/files/media/2026-05/Direct-Deposit-Form.pdf) (329.27 KB)

### Miscellaneous Benefits

- [Liberty Mutual - Discount Home & Auto Insurance ](https://drive.google.com/file/d/1GX6fz6fuf4BpA4h4pPrrz7uqy1otOa_A/view?usp=sharing)
- [TransitChek - Pre-Tax Commuting Assistance ](https://drive.google.com/file/d/1Spp15DoxwTaJ1co6jaPaBC6cb6HL68Hi/view?usp=sharing)
- [Verizon - Discount ](https://drive.google.com/file/d/1iwnRD7PMRnfZkqT-NAq1cFDqEAIq2hdX/view?usp=sharing)