Human Resources
Benefits
Annual Certification - Qualified Dependent (CO-1321)
Designation of Retirement Tier Plan Beneficiary (CO-931h)
Health Enhancement Program Enrollment Form
Leaves and Workers’ Compensation
American Red Cross Disaster Service Leave Request
Authorization for Disclosure and Release of Medical Information Form
Family Violence Leave Request
Medical Certificate Intake Form
Medical Certificate (for Graduate Assistants only)
Request for Leave of Absence (for Graduate Assistants only)
Request for Reasonable Accommodation Form for Employees
Return to Work (for Graduate Assistants only)
Workers' Compensation Packet
Personnel File
Recruitment, Classification, and Employment
Acknowledgement of Temporary Classified Appointment
Conflict of Interest Form (for Special Payroll)
Dual Employment Request Form.
Equal Employment Opportunity Information Sheet
Person of Interest (POI) Form
Reclassification Request for Research Assistants/Research Associates/Academic Assistants
Employee Relations
Waiver of Union Representation Form
Classified
Classified Vacation Carryover Form
Management/Confidential
Telecommuting and Flexible Work Schedule Form
Performance Evaluations for Academic Administrators
Performance Evaluations for Management/Confidential
UCPEA
Telecommuting and Flexible Work Schedule Form
UCPEA End-Date and Temporary Position Request Form
UCPEA Evaluation Form
UCPEA Compensatory Time Authorization Form
UCPEA Compensatory Time Request Payment Form
UCPEA Internship Request Form
UCPEA Position Audit Request Form
UCPEA Request for a Temporary Salary Increase (TSI)

UCPEA Professional Development
UCPEA Union Release Time
Please contact Human Resources at hr@uconn.edu to request Employee/Spousal Tuition Waiver information from prior semesters.
Statements Regarding Collection of Social Security Numbers on Forms
SSN required on University employment forms:
Federal tax regulations require the University of Connecticut Department of Human Resources to collect a social security number (SSN) from every employee who is paid compensation. Employee SSN’s are maintained and used by the University for payroll and benefits purposes, to verify employment history, and where required by law or for benefits purposes, to report the employee’s SSN on Federal and state agency forms. Except as mandated by law or as required for benefit purposes, the University will not disclose an employee’s SSN to any person or organization outside the University without the employee’s prior consent. Failure to provide a SSN to the University of Connecticut on required Human Resources forms may result in the withdrawal of an offer of employment and/or the denial of benefits.
SSN required by third party form (such as benefit form):
At times the University of Connecticut may provide University employees with forms on behalf of benefit providers and other organizations. Many of these forms require you to provide your social security number (SSN). As private companies it is within their rights to require you to provide your SSN in order to provide the requested service. These services typically include but are not limited to health and life insurance, retirement benefits, and employment verification. In addition, many State and Federal forms will also request your SSN. These forms may include, but are not limited to: tax and other compensation-related forms, background check forms for security sensitive positions, immigration forms, and forms for other government services. If you feel one of these third parties has misused your SSN, your first recourse is to contact the third party directly.