Hobart and William Smith Colleges

HUMAN RESOURCES FORMS

Benefits Related Forms

Certification of Marriage or Domestic Partnership and Declaration of Dependents (Word)
This form must be completed if employee wishes to cover his or her spouse (domestic partner for medical only) and eligible dependents under the Colleges' benefit programs.

Disability/Workers Compensation Forms

Accident Report
This form is used to report accidents that occur on campus property.

Short Term Disability Claim Form (PDF)
This form is used to claim for statutory disability benefits for an extended absence (longer than 7 consecutive days) due to a non-work related illness or injury. Employee completes Part A-Claimant then has his/her attending physician to complete Part B before returning to Human Resources.

Reasonable Accommodations for Employees with Disabilities
To request an accommodation please complete the accommodation request form and return it to Human Resources.

Management Forms

Position Approval Request (PAR)
This form is to assist supervisors/senior staff members in requests for new positions, fill vacancies, promotions, salary increases, change in status, etc. Completed PAR Forms must be approved by your senior division lead and submitted no later than two days prior to the next meeting date.

Summer / Fall 2022 Position Review Team meeting dates:
Jun 28, Jul 19, Aug 9, Aug 30, Sep 20, Oct 11, Nov 1, Nov 22, and Dec 13

Performance Management

• Core Capabilities
• Performance Appraisal Form

Youth Program Questionnaire
This form should be completed by any employee who oversees a youth program or activity sponsored by HWS, whether it takes place on campus or off campus.

Medical, Dental and Flexible Spending Account Claim Forms

FSA Handbook

AleraPay FSA Health/Dependent Claim Form
*To view your FSA account online please see this flyer*

COVID-19 Test Reimbursement Form (PDF)
COVID-19 Test Reimbursement Online Form

Dental Claim Form (PDF)
For the Guardian Dental plan.

Excellus Claim Form (PDF)

OptumRx Reimbursement Form (PDF)

Guardian Davis Vision Claim Form (PDF)

Guardian VSP Vision Claim Form (PDF)

Miscellaneous Forms

Faculty and Staff Gift Commitment Form - Payroll Deduction*
*To make your gift on a credit card please visit our secure online giving site at www.hws.edu/onlinegiving.

FMLA Forms:

Certification of Health Care Provider for Family Member's Serious Health Condition

Certification of Health Care Provider for Employee's Serious Health Condition

New Employee Hire Forms

Employment Eligibility
This form, known as the I-9, is required to be completed in the Human Resources Office on the employee's first day of work. Original documentation must also be presented at that time. Please review the I-9 List of Eligible Documents below.

I-9 List of Eligible Documents (PDF)
This list provides the approved documents that may be used to complete the I-9 form.

NYS IT-2104 (PDF)
This form is the US Employee's Withholding Allowance Certificate - it is the New York State tax withholding document.

W-4 Form (Federal Tax) (PDF)
This form is the US Employee's Withholding Allowance Certificate - it is the federal tax withholding document.

Retirement Forms

To enroll or change your Transamerica deferral, please refer to their website at www.trsretire.com.

Tuition Benefit Forms

Tuition Exchange
For the employee's dependent child. This form must be submitted to Human Resources in the fall prior to the start of the academic year that is to be considered. Questions of eligibility must be addressed with the Office of Human Resources. Also, a list of potential exchange schools must be submitted to the Financial Aid Office in order to reserve a potential tuition exchange scholarship at the desired schools. Tuition Exchange forms must be submitted each year to re-certify eligibility for the following year.

Tuition Grant
This form must be submitted to Human Resources with the school invoice for payment. If the College or University attending participates with Tuition Exchange, proof of denied Tuition Exchange application must be presented when applying for Tuition Grant.  A new invoice with tuition grant form must be submitted each semester to Human Resources for payment.

Tuition Reimbursement
For reimbursement of tuition costs for any course or courses taken by the employee in order to complete a first undergraduate degree. Individual courses that are not required as part of a degree program must be job-related in order to qualify for reimbursement. In either case, approval is required prior to registration for the course(s).

Tuition Remission Form - Employee
Tuition Remission Form - Dependent
For employee/spouse or domestic partner/dependent child who attends Hobart and William Smith Colleges. This form must be submitted to Human Resources prior to the academic year/semester to be considered. Tuition Remission forms must be re-submitted each year to re-certify eligibility for the following year.