Human Resources

Forms/Templates - Sorted by Category

Accident/ Injury

• Employee On-the-Job Accident and Injury Report - Procedures
  • Workers' Compensation Information: What You Need to Know
  • Lakeside Health System Workers' Compensation Guidelines
• Estimated Physical Capabilities
• Estimated Physical Capabilities (Security Services)
• Non-Employee Accident or Injury Report
  

Appointment/ Position

• Appointment/Status Change Recommendation
• Instructions for completion
  Form should be printed on ecru/ivory colored paper or light green colored paper for an appointment resulting from a search or a search waiver.
• Consulting Application
• Human Resource Management System Information Form
• Job Description Form - Guidelines
• State Employee Statement in Lieu of Oath Pursuant to Civil Service Law
• Offer Summary for Professional Appointment
• Offer Summary for Faculty Appointment
• Offer Summary for MC Appointment
• Outside Employment Form
• Position Request Form - Policy
• Prior Service Request - Academic Employees - Policy
• Prior Service Request - Professional Employees - Policy
• Retirement Bridge/Phased Retirement Program for Non-teaching Staff - Policy
• Summer-Winter Service Form-FT Faculty
• UP-211 Form: Reemployment of Retired Public Employees - Policy
• The Form I-9 (INS Employment Eligibility Verification) - more information
  Must be completed within 3 days of appointment date

Benefit/ Retirement Forms

• Blue Choice Turning 65 Form (Medicare Secondary)
• CSEA Employee Benefit Fund Application (Dental/Vision)
• CSEA Membership Application
• Dental and Vision Claim Forms
  • CSEA
  • MC, PEF, Security
  • UUP
• Employees Retirement System Forms
• MVP Turning 65 Form (Medicare Secondary)
• Opt Out Program (health insurance)
• Productivity Enhancement Program Enrollment (CSEA, MC, PEF)
• NYS Health Insurance Transaction Form (PS-404)
  
• NYS Health Insurance Transaction Form For Graduate and Teaching Assistants ONLY
  
• Salary Reduction Agreement - See Payroll Forms Below
• Tuition Assistance
• UUP Benefit Forms (Dental/Vision/Life/Address/Membership/Student Verification/others)

Directory

• Address/Name Change Form (online submission, must have NetID - same as email)
• Address/Name Change Form (hard copy)
  • Department Names Building Names
• Department Name Recommendation Form
  • Department Names

Extra Service

• Dual Employment Approval Form (Other Agency)
• UP-8 (Full-time UUP)
  • Guidelines on Form Completion and Matrix of Extra Service Forms Required for Payment
• Classified Extra Service Approval Form
• Professional/Faculty Extra Service Approval Form
• UP-6 Request for Extra Service Approval for M/C Employee (Other Agency)
• Extra Service Voucher - Guidelines for Completing Voucher

Evaluation/ Performance Program/ Probation

• Evaluation Calendar - All Employees
• CSEA Employees
• Evaluation Form - CSEA Employees
  • Guidelines for CSEA Evaluation
• Classified Performance Evaluation Forms Completion Help
• Evaluation - CSEA Appeals Form
• Appealing CSEA Unsatisfactory Performance Evaluation
• Probationary Period Form - CSEA Employees -
  • Guidelines for Probationary Period Form
• Probation Memo
• Professional Employees
  • Evaluation Form - Professional Employees - print on ecru or ivory colored paper
    • Evaluation System for Professional Employees (A-28)
      
• Performance Program Form - Professional Employees - print on light green colored paper
  • Guidelines for preparing Professional Performance Program
    Guidelines for Developing Mission Statements
    
• PEF Employees
  • Evaluation/Performance Program - PEF Employees
• Evaluation/Performance Program Employee Worksheet - PEF Employees
• M/C Employees
  • Evaluation/Performance Program - M/C Employees
• ALES Employees
  • Evaluation Form - ALES Employees
• Security Services Unit Employees
  • Evaluation Form - Security Services Unit
• Security Services Supervisor Unit Employees
  • Evaluation Form - Security Supervisor Unit

Immigration/Visa Forms

• Employee Questionnaire in Connection with Permanent Employment Certification
• Employer Questionnaire in Connection with Permanent Employment Certification
• Immigration Initiation Form
• H-1B Employer Questionnaire
• Visa Employee Questionnaire

Leaves - See Full Listing of Leaves

Miscellaneous

• Action Request -Form Memorandum to Request Review and/or Approval
• Adele Catlin Award Nomination Form
• Alternate Work Location Form
• Chancellor's Award for Excellence in Classified Service Guidelines and Nomination Package
• Composition of Committees Template
• Confidentiality
• DSI Nomination Form (Professional)
• HR Customer Service Survey - "Tell Us..."
• LENS Request Form for 15 Passenger Vans- Verification of Driver's License
• LENS Request Form for New Employees - Verification of Driver's License
• Mailing Label Request
• New Proposal Initiative
• Outstanding Service Award Nomination Form
• Outstanding Service Award Nomination Checklist
• Recognition Form
• Separation Form - Employee and Supervisor must complete upon separation from employment
• Time Sheets - See Payroll
• UUP College Panel Review Request Form
• UUP Request for Promotion Form
• Workplace Violence Prevention Risk Assessment Form
  • Workplace Violence Prevention Guide to Completing the Risk Assessment Form

Payroll Forms

• Direct Deposit Form (PDF)
• Holiday Pay Waiver
• Leave Donation Form
• Salary Reduction Agreement
  • SRA 2013 Limits
• Savings Bonds - AC-3245 TreasuryDirect Direct Deposit Transactions
• Time Sheets - See Payroll
• Withholding
  • IT-2104(NYS) Employee's Withholding Allowance Certificate
  • IT-2104E(NYS) Certificate of Exemption From Withholding
  • W-4 (Federal) Employees Withholding Allowance Certificate

Vacancy Announcement

• Professional/ Faculty Position Vacancy Announcement
• Staff Vacancy Announcement (Classified)

 

News

Brockport's Class of 2013 Joins Alumni Ranks

Brockport Celebrates 2013 Graduate Student Commencement

The College at Brockport Celebrates Commencement May 17-18

Brockport and Nazareth Forge Partnership with Jefferson Community College

Events

Tue, May 21

Career Services Candidate/EMSA Directors
8:45 am - 9:30 am

Career Services Candidate Open Forum
9:45 am - 10:30 am

Career Services Search Committee
1:30 pm - 3 pm