HR & Payroll Forms

Human Resources Forms

• Accommodation Request Form/Statement of Workplace Needs (PDF)
• AFLAC Cancellation Form (PDF)
• AFSCME Grievance Form (Dynamic Form)
• APA Bi-Annual Report to Administrative Area Supervisor (Employee)* (MS Word)
• APA Annual Performance Narrative Form (Supervisor)* (MS Word)
• CORI/SORI Acknowledgement Form
• Demographic Change Form
• Emergency Contact Form (Dynamic Form)
• Fitchburg State Continuous Payroll Direct Deposit Contribution Authorization Form (PDF)
• Internal Transfer Form
• Interview Exchange Employee Access Request Form (job site access)
• Name Badge Request Form (Dynamic Form)
• New Employee Data Form (AFSCME)
• New Employee Data Form (APA/MSCA/NUP)
• New Hire Form
• Payroll Public Records Exemption Form (PDF)
• Reclassification Packet (AFSCME) (PDF)
• Separation Notification Form
• Separation Notification Form - students
• Student Clearinghouse Authorization (PDF)
• Tuition Remission Form (PDF)
• Tuition Remission Form - Fitchburg State University Classes ONLY (Dynamic Form)

COVID Forms

• Request a Reasonable Accommodation Due to COVID
• Alternate Work Option Request (COVID) 
• Faculty and Staff Travel/Self Isolation 
• Symptom Monitoring Form

Payroll Forms

Employee Forms

• Direct Deposit (MS Word)
• Post-Retirement Statement of Earnings (PDF)
• Post Retirement Maximum Earnings Calculation Examples (PDF)
• Salary Reduction Agreement Form 403(b) (PDF)
• State Board of Retirement Contractor Service Buyback (PDF)
• W-4 (Federal Tax Form) 
• M-4 (State Tax Form) 
• I-9 (Employment Eligibility Verification Form) (PDF)

Part-Time Contractor Employment Forms

• Standard Contract
• Commonwealth Terms and Conditions 
• OBRA Enrollment Form (Mandatory) (PDF)
• OBRA Enrollment Form (Voluntary) (PDF)
• OBRA Beneficiary Form (PDF)
• Exempt from OBRA Form (PDF)
• SSA - 1945 Form (PDF)
• Rehire/Transfer Notification Form 
• Payment Voucher

Student Employment Forms

• Direct Deposit (MS Word)
• I-9 (Employment Eligibility Verification Form) (PDF)
• Student Employment Authorization
• M-4 (State Tax Form) 
• W-4 (Federal Tax Form)
• W-4 Student Guide (PDF)
• OBRA Mandatory Enrollment Form (students working during the summer and not enrolled in summer classes) (PDF)