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

Supplemental Retirement 403(b) Plan Loan Application

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) Tier Election Form

Basic Retirement Plan 401(a) Allocation Change Form

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

Dependent Information Request Form

CDL Drug and Alcohol Testing

• Certificate of Receipt of Drug and Alcohol Testing Policy (pdf)
• Certificate of Drug and Alcohol Training (pdf)

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

Miscellaneous

Alternative Work Arrangement Request Form

• Overtime Authorization Agreement (pdf)
• Permission to Engage in Outside Activity Form can be completed through NUgrant at nugrant.unl.edu.
• Volunteer Form (pdf)
• Injury/Property Damage Report (pdf)
• Student Field Trip Insurance (pdf)
• Student Worker Agreement (pdf)

New Hire

• Confidentiality Agreement Form (pdf)
• Compensatory Time Agreement (pdf)
• Direct Deposit (pdf)
• I-9 Form, Employment Eligibility Verification (U.S. Citizenship & Immigration Services)
• NCard for UNL Faculty & Staff
• PAF (Personnel Action Form) (pdf)

NU Values Compensation & Evaluation

• Login to the Job Description System (PeopleAdmin)
• Salary Determination Form
• Performance Evaluation Form (Performance Management Overview)

Recruitment and Offer

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

Microsoft Word letters of acknowledgement, offer or decline:

• Letters of Offer
• Letters of Decline
• Letter of Acknowledgement

Worker's Compensation

• First Report of Alleged Occupational Injury or Illness (pdf)
• Supervisors Incident Analysis Report (pdf)
• Workers' Compensation Incident Report
• 7 Day Waiting Period Acknowledgement (pdf)
• Employee's Choice or Change of Doctor (pdf)
• Release to Return to Work (pdf)
• 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)