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FORM |
Format |
|
|
Annual Employment Letters
(Sample Letters: 1 and 2) |
Word |
|
Annual Review of Research Associate, Post
Doctoral Fellow, and Research Faculty |
Word |
|
Applicant Reference Check |
PDF |
|
Application
for Coverage, State and School Employees' Health Insurance Plan
(12/06) |
PDF |
|
Careflex:
Reimbursement Request for Your Flexible Benefits Plan
|
PDF |
|
Careflex:
Dependent Care Certification Form |
PDF |
|
CatalystRx Direct Member Reimbursement Form |
PDF |
|
Classification Checklist for PERS Retiree
(hired
as a consultant) |
PDF |
|
Compensatory
Time Record
(HRM 311C) |
PDF |
|
Consent for Release of Alcohol and Drug Testing Data |
PDF |
|
Consulting Services Cover Sheet and Classification Checklist (HRM 322 and 323) - See also
PERS Classification Checklist if the
consultant is a PERS retiree. |
PDF |
|
Delta
Dental Claim Form |
PDF |
|
Delta
Dental Identification Card. As an enrollee with Delta Dental
Premier® or Delta Dental PPOSM coverage, you don't need an ID card. When
visiting a Delta Dental Premier or Delta Dental PPO dentist, simply
provide your social security or identification number. The dental office
can use that information to verify your eligibility and benefits.
If you still would like an ID card, you can print a customized ID card
on demand. Just follow Delta Dental's easy, three-step registration
process and log in to their online benefits and eligibility system. Once
you've logged in, click the "Eligibility & Benefits" tab to view your
eligibility and benefits information and to print an ID card.
From the Eligibility page, select the button labeled ID Card. |
Web Form |
|
Dependent Care Certification Form -
Careflex |
PDF |
|
Direct
Deposit Authorization |
PDF |
|
Direct
Deposit for Mediflex and Careflex Reimbursements |
PDF |
|
Donated Leave:
Application for Donated Leave
(HRM 228) |
PDF |
|
Donated Leave:
Application to Donate Leave (HRM 228B) |
PDF |
|
Donated Leave:
Application to Receive
Donated Leave (HRM 208A) |
PDF |
|
Employment
Action Form (EAF) |
PDF |
|
Exit Survey
(HRM 60 405) |
PDF |
| Faculty Pay Distribution Agreement Form |
PDF |
|
FMLA Notice Letter |
PDF |
|
Goals Worksheet (Executive, Professional, and Supervisory
Employees) |
PDF |
|
Human
Resources Information Form |
PDF |
|
I-9
Instructions and Form |
PDF |
| I-9 Employers Handbook -Instructions for completing the Form I-9 |
PDF |
|
Job
Inventory Form (JIF) (Save to a local drive.) |
Word |
|
Kroll Form- Background Screen Authorization |
PDF |
|
Leave:
Application
for Leave
(HRM 60-201) |
PDF |
|
Leave:
Application
for Leave of Absence Without Pay
(HRM 201A) |
PDF |
|
Medical
Certification for Major Medical Leave or Family and Medical Leave,
Medical Leave of Absence, Excuse/Release to Work |
PDF |
|
Medical
Claim Form (State and Public School Employees' Health Insurance Plan) |
PDF |
|
Mediflex: Pharmacy Debit Card Enrollment/Cancellation Form |
PDF |
|
Mediflex: Reimbursement Request for Your Flexible
Benefits Plan |
PDF |
|
Mississippi Employee's Withholding Exemption Certificate |
PDF |
|
Offer Letters - Faculty Positions |
PDF/DOC |
|
Offer Letter - Support Staff Employee |
PDF |
|
Offer Letter - Executive, Administrative,
Managerial, and Other Professional Staff
(non-contract employees) |
PDF |
|
Offer Letter - Executive, Administrative, Managerial,
and Other Professional Staff
(contract employees) |
PDF |
|
Offer Letter - Intermittent
|
PDF |
|
Offer Letter - Rehired Retiree - Non-Lecturer
|
PDF |
|
Offer Letter - Contract Faculty
|
PDF/DOC |
|
Offer Letter - Faculty Lecturers, Rehired Retiree Lecturers
|
PDF/DOC |
|
Offer Letter - Research Non-Contract Professionals-External Funded Projects
|
PDF/DOC |
|
Offer Letter - Research Faculty (Contract)
|
PDF |
|
Outside Employment
(HRM 415) |
PDF |
|
Performance Appraisal of MSU Staff: Forms and
Learning Resources (requires NetID and NetPassword) |
Web Site |
|
PERS Forms Library |
Web Site |
|
PERS Classification Checklist
(use when hiring a PERS retiree as a consultant) |
PDF |
|
PERS: 4A Noncovered
Employment Acknowledgment |
PDF |
|
PERS: 4B Certification/Acknowledgment of Reemployment of Retiree |
PDF |
|
Personal Demographic Data |
PDF |
|
Pharmacy Benefit: CatalystRx Order Form for Mail Service Pharmacy, Fax Order
|
PDF |
|
Position Approval Request Form, PARF (HRM
103) |
PDF |
|
Release of Employee Benefits Information (requires
notary witness for completion outside HRM) |
PDF |
|
Release of Employee Benefits Information (to be
completed in HRM) |
PDF |
|
Request
for Other University Employment Activity
|
PDF |
|
Request for Salary Adjustment: Staff Position
(HRM 61.02A) |
PDF |
|
Salary/Wage
Reduction Agreement for Tax-Deferred Annuities |
PDF |
|
Securing
and Paying for Consultants and Independent Contractors Policy and
Procedure (includes links to Consulting Services Cover Sheet) |
PDF |
|
Separating Procedure Checklist |
PDF |
|
Summer Appointment Request Form |
PDF |
|
Time Report: Non-Exempt Employee Semi-Monthly Time Report (Save to a local
drive.) |
Excel |
|
Tuition Remission:
Application
for Tuition Remission: Employee (HRM 60-225) |
PDF |
|
Tuition Remission:
Application
for Tuition Remission: Dependent Child (HRM 60-226) |
PDF |
|
Form W-4 Employee's Withholding Allowance Certificate |
PDF |
|
Workers'
Compensation: First Report of Injury or Illness |
Users with full Adobe Acrobat application can complete and save the file and
send it as an e-mail attachment to workerscomp@hrm.msstate.edu . |
PDF |
|
Work Record: Exempt Rehired Retiree |
PDF |
|
Mississippi State University complies with all
applicable laws regarding affirmative action and equal opportunity in all
of its activities and programs and does not discriminate against anyone
protected by law because of age, color, disability, national origin, race,
religion, sex, handicap, or status as a veteran or disabled veteran.
Last modified March 25, 2008
Technical
problems, contact the
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