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Human Resources Forms

Application for Employmentpdf (fillable)

Appointment Processing Forms

Business Card Request Form - pdf (fillable)

New Instructor Information

Off-Site Instructor Information


Dental and Vision Forms

CSEA Dental Form - pdf

GHI Dental Form (M/C Employees) -pdf

Delta Dental Claim Form (UUP)

Davis Vision Direct Reimbursement Claim Form (UUP and M/C Employees)

Benefit Trust Student Verification Form (UUP)

Dependent Care

Dependent Care Advantage Account Reimbursement Form - pdf


Driving - SUNY Delhi Driver Information Form - word

Driving - SUNY Delhi Driver Information Form - pdf (fillable)

Evaluation, Performance Program and Annual Report Forms

CSEA Performance Program and Evaluation - word (fillable)

Security Supervisors' Performance Program and Evaluation

Faculty Annual Report and Performance Program - Revised 9/11 - word

Faculty Annual Report and Performance Program - Revised 9/11 PDF (fillable)

PEF Performance Program and Evaluation Form - PDF

PEF Performance Program and Evaluation Form - PDF (fillable)

Professional Employees' Evaluation Report

Professional Employees' Performance Program

Professional Employees' Performance Program - PDF (fillable)

Security Employees Performance Program and Evaluation

Faculty Promotion Forms

Faculty Promotion Release Statement - word

Faculty Promotion Release Statement - pdf (fillable)


Academic Data Summary - word


Health Insurance Forms

Empire Plan Claim Form - pdf (fillable)

Health Care Spending Account Reimbursement Form - pdf (fillable)

Health Insurance Enrollment Form - pdf

HMO Enrollment Form - pdf

Leave Forms

Leave Form -word

Leave Form - pdf (fillable)

Leave Donation Form - pdf (fillable) 

Unclassified Staff Leave Report - pdf (fillable)

Family Medical Leave Act Forms

FMLA Rights and Responsibilities Notice Employee’s Serious Illness 

Family Member’s Serious Illness 

Military Family Leave 

Military Family Member’s Injury FMLA Notification Form 

FMLA Approval/Disapproval Form


Retirement Forms

New York State Employees' Retirement System Forms (ERS)

New York State Teachers' Retirement System Forms (TRS)


Salary Reduction Agreement Form

Search Forms

Hiring Process for New Positions 

Request To Fill Form - pdf

Candidate Interview Report

Candidate Interview Report - pdf (fillable)

Hiring Procedure Report

Hiring Procedure Report - pdf (fillable)

Interview Exchange Information Request

Student Employment Forms

College Work Study Request Form - pdf (fillable)

Student Assistant Request Form  - pdf (fillable)

Student Employment Application - pdf (fillable)

Work Study Evaluation Sheet - pdf (fillable)

Student Assistant Evaluation Sheet - pdf (fillable)

Summer 2013 - Student Request Form - pdf (fillable)

Confidentiality Compliance Agreement for Student Employees - pdf

Tax Withholding and Other Payroll Forms

Federal Tax Withholding Form W-4 Form - pdf (fillable)

New York State Tax Withholding Form IT-2104 - pdf (fillable)

New York State Tax Exempt Form IT-2104e - pdf (fillable)

Direct Deposit Form - pdf (fillable)

Change of Address - pdf (fillable)

Tuition Assistance

Tuition Assistance Application Form

UUP Waiver Registration Form - SUNY Delhi - pdf (fillable)

Employee Mandatory Fee Waiver Request Form - word

UUP Individual Development Awards

Supplemental Information Form

Supplemental Information Form - pdf (fillable)

Exit Process Forms

Responsibilities During Exit Process - pdf



Discrimination Complaint Form - word

Discrimination Complaint Procedure - pdf




Additional Info

About the Area
Campus Safety Report
Civil Service Examinations
Dual Career Assistance
Driver Approval Process
Ethics in State Government
GOER Online Courses
Guidelines for Search Committees
Holidays 2014
Info for Distance Learning Faculty
Mail Handling Protocols
Resources and Links
Retiree Organization
Staff Development
SUNY HR Web Site
SUNY Policies of Board of Trustees
Supervisors Guide to Counseling
Violence & Harassment Prevention

PDF Icon Faculty & Staff Handbook

Contact Info
P: 607-746-4495 
F: 607-746-4158


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Last Updated: 11/12/14