Forms:
PLEASE NOTE: Some forms on this page are in .PDF format. If you do not have an Adobe reader, please visit the Adobe site for instructions on how to download and install the free software.
Title |
Remarks |
Agency |
| Accident Report - Employee | If there is an accident while on duty, the employee must complete an accident report and submit it to HR. | GCC |
| Accident Report - Supervisor | If there is an accident while on duty, the employee's supervisor must complete an accident report and submit it to HR. | GCC |
| Cash Match Agreement Form | Use this form to direct your Virginia Cash Match employer contribution to the participating provider company of your choice. Upon completion, return this form to the participating provider for processing through FBMC. | FBMC |
| Computer Ethics Agreement | Information concerning any access and use of information technology systems. | VCCS |
| Direct Deposit | Authorization to have check automatically placed in bank account. | GCC |
| Used by Employees to document their accomploishments as well as areas of improvement to assist supervisor in completing a thorough evaluation of performance. | DHRM |
|
| Employee Work Profile (EWP) | Employees duties/responsibilities | DHRM |
| Extraordinary Contributor | Use when documenting/recognizing an extraordinary contribution made in the performance of duties. | DHRM |
| Flexible Reimbursement Account Election Form |
Use this form to enroll in or make changes to your Flexible Reimbursement Accounts (FRAs) or enroll/make changes online at Employee Direct. | DHRM |
| Health Care Enrollment/Waiver Form |
This form may be used by the newly-eligible employee to enroll in a State sponsored health plan or by employees who experience a qualifying mid-year event to make changes to their coverage outside of the open enrollment period. Employees completing their six-month waiting period may use this form to enroll in a Medical FRA. Employees may enroll in or make changes to their coverage online at Employee Direct. If you choose to use this form, you must return it to the Human Resource Office within 31 days of eligibility or the event allowing a change outsided of Open Enrollment. | DHRM |
| Health Care Enrollment/Waiver Form | Retiree's and Disability | DHRM |
| Health Care Reimbursement Claim Form | Use this form to file a claim for health care services that you have paid full price for and a doctor or facility has not file a claim directly with Anthem Blue Cross and Blue Shield on your behalf. | Anthem |
| Immediate Recognition Award Form | Form used by supervisors to recognize individuals or teams for extraordinary contributions or outstanding performance. | |
| Interim Evaluation Form | All NEW employees should have an Interim Evaluation Form completed within 90 days of hire. | DHRM |
| I-9 Form | ALL Employees Part-time/full-time must complete | Federal |
| Leave Request Form (Exempt Staff Only) |
Exempt employees (those that do not complete a timesheet) must complete and submit to supervisors prior to taking leave. | GCC |
| Pay Action Worksheet | Use for CLASSIFIED Staff Pay Changes. | DHRM |
| Personnel Request Form | Use when requesting a position be opened, or when changing the number of hours applied to an existing P-14 position. | GCC |
| Prescription Home Delivery Order Form | Use this form to obtain up to a 90-day supply of medication taken routinely, such as medication to treat high blood pressure, asthma, diabetes, or other conditions. If this is your first home delivery order for a medication, also complete the Health, Allergy & Medication Questionnaire and mail it with your order. | Medco |
| Prescription Reimbursement Form | Only use this claim form when you have paid a pharmacy full price for a prescription drug order because the pharmacy does not accept your prescription member card or you have not received your memeber ID card yet. | Medco |
| Health, Allergy & Medical Questionnaire Form | Required form when submitting first time home delivery order for medication. | Medco |
| Purchase of Prior Service Application | Complete this form to apply for the purchase of prior service credit. | VRS |
| Trustee-to-Trustee Purchase of Prior Service | Complete this form to purchase prior service with funds from a deferred compensation or other tax sheltered account. | VRS |
| Trustee-toTrustee Purchase of Prior Service Fact Sheet | Fact sheet outlining trustee-to-trustee purchase of prior service process. | VRS |
| Quarterly Training Report | GCC |
|
| Reference Check Form | Use when checking references on a potential hire. | GCC |
| Salary Reduction Agreement | Use this form when authorizing payroll deductions for supplemental insurance policies and pre-tax annuities. | DOA |
| VACU Payroll Direct Deposit | The Virginia Credit Union's version of Direct Deposit, used to set up monthly deduction of pay for savings, loans and other financial transactions. | VACU |
| VCCS-10 | Faculty Qualification Summary | VCCS |
| VA State Application | Use to apply for positions with the Commonwealth of Virginia. | DHRM |
| VA-4 (Tax Form) | Virginia Personal Exemption Worksheet is used to indicate the amount of tax dollars you want withheld from your pay. | State |
| W-4 (Tax Form) | Use to indicate the amount of tax dollars you want withheld from your pay. | Federal |