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)
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 Worker Agreement (pdf)
- Student Overtime Authorization (pdf)
- Volunteer Form (pdf)
New Hire
- New Employee Information Sheet (pdf)
- 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
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)