Forms Directory

If you have any questions regarding how to complete any of these forms, please call Human Resources at 402-472-3101.

Many of the forms below are in portable document format (PDF). Learn how to fill and sign forms using Acrobat Reader.

Benefits & Retirement

University of Nebraska Employee Benefit Forms (NUFlex, Prescription Drug Program, Vision Care Insurance, Life, Accidental Death & Dismemberment and Dependent Life Insurance, Flexible Spending Account, Retirement Plan, and Other Forms)

Benefits Change Form

Dependent Information Request Form

Record of Prior Service for Basic Retirement Plan 401(a) Application

Basic Retirement Plan 401(a) Tier Election Form

Supplemental Tax Sheltered Annuity 403(b) Program Pretax Salary Reduction / Roth Deduction Agreement

Deferred Compensation Retirement 457(b) Plan Salary Reduction Agreement

Basic Retirement Plan 401(a) Allocation Change Form

Supplemental Retirement 403(b) Plan Loan Application

Leave Requests

• Certification of Health Care Provider (pdf)
• Crisis Leave Request (pdf)
• Family/Medical Leave (FML) Request (pdf)
• Request for Leave (pdf)

You may be eligible to use Crisis Leave in conjunction with Family Medical Leave per policy

Risk Management

Permission to Engage in Outside Activity

Request an Insurance Certificate

• Injury/Property Damage Report(pdf)
• Student Field Trip Insurance (pdf)
• Student Worker Agreement (pdf)
• Student Overtime Authorization (pdf)
• Volunteer Form (pdf)

New Hire

• Commercial Driver's License (CDL) drug testing: Supervisor's form and Driver's form
• Competency-based Interview Questions (pdf)
• Confidentiality Agreement Form (pdf)
• Direct Deposit (pdf)
• Driving Record Review (pdf)
• Employing or Purchasing from a Family Member-Procedures & Approval (pdf)
• I-9 Form, Employment Eligibility Verification (U.S. Citizenship & Immigration Services)
• Managerial/Professional Recruitment Checklist (pdf)
• Office/Service Recruitment Checklist (pdf)
• NCard for UNL Faculty & Staff
• PAF (Personnel Action Form) (pdf)

NU Values Compensation & Evaluation

• Compensatory Time Agreement (pdf)
• Overtime Authorization Agreement (pdf)
• Salary Decision Guide (pdf)
• Salary Determination Form (pdf)
• Performance Evaluation Form (docx)

Recruitment and Offer

• Criminal History Disclosure Form (pdf)
• Reference Check / Release of Liability (pdf)
• Telephone Reference Checklist (docx)

In SAPPHIRE: UNL > Payroll and Human Resources > Hiring Resources > Letters to Applicants and New Hires.

• Letter of acknowledgement
• Letters of offer & Employee Information Sheet
• Letters of decline

Worker's Compensation

To be filled out by supervisor

• First Report of Alleged Occupational Injury or Illness (pdf)
• Supervisors Incident Analysis Report (pdf)

To be filled out by injured employee

• Workers' Compensation Incident Report
• 7 Day Waiting Period Acknowledgement (pdf)
• Employee's Choice or Change of Doctor (pdf)

To be filled out by Attending Physician

• Release to Return to Work (pdf)

Additional

• Employee Mileage Forms (pdf)
• First Script Workers Compensation Program- English (pdf) (en español)
• HIPPA Compliant Release (Benefits Office use only) (pdf)
• Witness Statement Form (pdf)