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
Leave Requests
- Family/Medical Leave Certification of Health Care Provider PDF
- Family/Medical Leave (FML) Request PDF
- Crisis Leave Request PDF
NU Values Compensation & Evaluation
Recruitment and Offer
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
- New Employee Information Sheet
Worker's Compensation
To be filled out by supervisorTo 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