HR & Payroll Forms

Human Resources Forms

• 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)
• Blood Donation Leave Form for Commonwealth of Massachusetts Employees (MS Word)
• CORI/SORI Acknowledgement Form (Dynamic Form)
• Demographic Change Form (Dynamic Form)
• Departmental Flexible Work Arrangement Form (Dynamic Form)
• Emergency Contact Form (Dynamic Form)
• Employee Flexible Work Arrangement Form (Dynamic Form)
• Fitchburg State Continuous Payroll Direct Deposit Contribution Authorization Form (PDF)
• Internal Transfer Form (Dynamic Form)
• Name Badge Request Form (Dynamic Form)
• New Employee Data Form (AFSCME) (Dynamic Form)
• New Employee Data Form (APA/MSCA/NUP) (Dynamic Form)
• New Hire Form (Dynamic Form)
• Payroll Public Records Exemption Form (PDF)
• Reclassification Packet (AFSCME) (PDF)
• Request for Reasonable Accommodation Form (Dynamic Form)
• Separation Notification Form (Dynamic Form)
• Separation Notification Form - students (Dynamic Form)
• Student Clearinghouse Authorization (PDF)
• Tuition Remission Form (PDF)
• Tuition Remission Form - Fitchburg State University Classes ONLY (Dynamic Form)

COVID Forms

• Booster Vaccination Attestation Form (Google Doc)
• Symptom Monitoring Form (PDF)

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) (PDF)
• M-4 (State Tax Form) (Dynamic Form)
• I-9 (Employment Eligibility Verification Form) (PDF)

Part-Time Contractor Employment Forms

• Standard Contract (Dynamic Form)
• Commonwealth Terms and Conditions (PDF)
• 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 (Dynamic Form)
• Payment Voucher (Dynamic Form)

Student Employment Forms

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