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More Great Benefits

Form Description
Life Insurance and AD&D Beneficiaries Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form to name your beneficiaries for your optional life insurance and optional accidental death & dismemberment insurance.

EAHP Application

This form allows UK Employees to apply for the Employer Assisted Housing Program.

EAHP map

This map outlines the area surrounding UK that defines the boundaries of the UK Employee Assisted Housing Program.

EEP Tuition Waiver for Murray State

Employees of Murray State who participate in the Employee Education Program must fill out and submit this tuition waiver form.

Family Education Program (FEP) Enrollment Form

As a UK employee, you have the opportunity to enroll a family member in the Family Education Program through UK.

Flexible Spending Account Enrollment Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Use this form to enroll in health and/or dependent care flexible spending accounts (FSA). You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Flexible Spending Account Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form to enroll in health and/or dependent care flexible spending accounts (FSA). You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Flexible Spending Claim Form
Life Insurance and AD&D Beneficiaries Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Use this form to name your beneficiaries for your optional life insurance and optional accidental death & dismemberment insurance.

Life Insurance and AD&D Enrollment Form 2019-20
Plan year July 1, 2019 through June 30, 2020

Use this form to enroll in additional life insurance coverage for yourself, spouse/sponsored dependent, or children. This form also allows you to enroll in separate accidental death & dismemberment insurance.

Life Insurance and AD&D Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form to enroll in additional life insurance coverage for yourself, spouse/sponsored dependent, or children. This form also allows you to enroll in separate accidental death & dismemberment insurance.

MetLaw Enrollment Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Use this form to enroll in legal services insurance.

MetLaw Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form to enroll in legal services insurance or cancel it.

One-time exception to allow 9 credit hours in one semester request form

This form allows enrolled participants in the Employee Education Program to request a one-time exemption from the semester limit to the number of hours an employee can take.

Tuition waiver FERPA release form

This form is for use by students who are also employed by the University of Kentucky as regular employees using the tuition waiver benefit to attend other Kentucky state-funded institutions. Students who wish to use the tuition waiver benefit must release their academic records in order for University of Kentucky Human Resources to receive academic records from these other Kentucky public institutions. The information is for internal use only, related to benefit eligibility and administration and will not be shared with any parties outside of the University of Kentucky.

Tuition waiver form for classes at another Kentucky public institution (Faculty and Staff Tuition Waiver)

Faculty and staff who applied to or were enrolled in another state-funded institution in Kentucky and were a benefits-eligible employee at UK before April 26, 2018, should use this form to request a waiver for their tuition.

Tuition waiver form for classes at UK (EEP form)

This fillable form allows UK Employees to enroll in the Employee Education Program (EEP) at UK.

HR Home

Form Description
Absence Record

This is a printer-friendly absence request form used for some University areas. Note: Main campus (non-UK HealthCare areas) now typically submit leave requests online through myUK Employee Self-Service

Drug Free Policy Certification Form

The Federal Drug-Free Workplace Act of 1988 (section 5151) requires that all employees receive a copy of the University's policy, which declares that UK is a drug-free workplace. This policy notification and this certification form insure the University's compliance with the federal law. 

myUK ESS Guide

Form Description
Absence Record - (IRIS)

Retiree Medical Plans

Form Description
ACH Bank Draft Authorization Form

Fill out and submit this form to enable automatic monthly payment of your UK Retiree Health Insurance premiums by bank draft (ACH).

Retiree Benefits Enrollment Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Retirees should use this form to enroll in health, dental and vision plans.

Retiree Benefits Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Retirees should use this form to enroll in health, dental and vision plans.

Retiree Health Coverage Deferral
Retiree Health/Dental/Vision Form 2019

Retirees should use this form to enroll in health, dental and vision plans beginning Jan. 1, 2019.

Benefits

Form Description
Address change form

Change your permanent address online using myUK, or submit the PDF form.

Name Change Form

Use this form for any name change(s). Note: The employee completes the form with the appropriate change. Then, employee takes form to HR Benefits Office for entering into SAP. HR Benefits Office enters change into SAP. HR Benefits Office then forwards form to Compensation. Compensation will forward form to Employee Records after processing, where the copy will be filed in the individual’s Employee Record File. To change home and work addresses, go to myUK at https://myuk.uky.edu and update using the Employee Self Service (ESS) portal.

Release of Health Information

Authorize an individual(s) to contact the benefits office and receive information regarding UK benefits on employee’s behalf.

Retirement

Form Description
Allocated Spending Goals

Write a list of everything you would like to do from most important to least important. When you get extra money from any source, apply it to these goals. Item one may be new clothes for $100, item two could be a weekend trip away for $300, and item three could be pay off a credit card for $800. If you receive a $600 tax refund, you could do the first two items and put the remaining $200 towards the credit card debt.

Basic Cash Flow Plan

More than a budget, this will help plan what bills will be paid with each paycheck.

Debt Snowball Form

This form can give you a game plan to pay off your debt. List debts from smallest to largest, pay as much as you can on the smallest and the minimum on the rest.  As one debt is paid off, add the amount you were paying monthly on that debt to the minimum payment on the next debt on the list.

Faculty Phased Retirement Agreement

Use this form for faculty requesting entry into a Phased Retirement process.

Fidelity 457b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to enroll in voluntary UK 457(b) retirement savings plan through Fidelity. This form is also used for designating a beneficiary.

Fidelity 457b Enrollment Form - Hired On or Before June 30, 2015

Employees who were hired on or before June 30, 2015, should complete this form to enroll in voluntary UK 457(b) retirement savings plan through Fidelity. This form is also used for designating a beneficiary.

Fidelity Mandatory 403b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to make mandatory 403(b) retirement savings plan contributions to Fidelity Investments and designate beneficiaries.

Fidelity Mandatory 403b Enrollment Form - Hired On or Before June 30, 2015

Employees who were hired on or before June 30, 2015, should complete this form to make mandatory 403(b) retirement savings plan contributions to Fidelity Investments. 

Fidelity Voluntary 403b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to make voluntary 403(b) retirement savings plan contributions to Fidelity Investments and designate beneficiaries.

Fidelity Voluntary 403b Enrollment Form - Hired On or Before June 30, 2015

Employees who were hired on or before June 30, 2015, should complete this form to make voluntary 403(b) retirement savings plan contributions to Fidelity Investments and designate beneficiaries.

Income and Expense worksheet

This worksheet will give you a good basic understanding of what your current income and expenses really are.

Salary Reduction Agreement for UK Matching Retirement Savings Plan

Complete this form to authorize payroll deductions as contributions to UK's Matching Retiremtn Savings Plan.

Staff Phased Retirement Agreement

This form allows staff of UK to enter a Phased Retirement process.

TIAA 403b Enrollment Form - Hired On or Before June 30, 2015

Employees who were hired on or before June 30, 2015, should complete this form to make 403(b) retirement savings plan contributions to TIAA and designate beneficiaries.

TIAA 457b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to make 457(b) retirement savings plan contributions to TIAA and designate beneficiaries.

TIAA mandatory 403b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to make mandatory 403(b) retirement savings plan contributions to TIAA and designate beneficiaries.

TIAA voluntary 403b Enrollment Form - Hired After June 30, 2015

Employees who were hired after June 30, 2015, should complete this form to make voluntary 403(b) retirement savings plan contributions to TIAA and designate beneficiaries.

Voluntary 403(b) Salary Reduction Authorization - 2020

Use this form for additional voluntary contributions, over and above the standard 5 percent 403(b) employee contribution.

Voluntary 457(b) Salary Reduction Authorization - 2020

Use this form for voluntary contributions to a UK 457(b) retirement savings plan, separate from UK's 403(b) retirement plan.

Employee Medical Plans

Form Description
Anthem manual claims form

Use this form to manually submit a health insurance claim with Anthem.

COBRA enrollment form 2019-20

Plan year July 1, 2019 through June 30, 2020

Use this form to enroll in COBRA insurance coverage, available to UK employees which allows you to continue your group health, dental and vision insurance on an individual basis when you or your dependent(s) become ineligible for University benefits.

COBRA enrollment form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form to enroll in COBRA insurance coverage, available to UK employees which allows you to continue your group health, dental and vision insurance on an individual basis when you or your dependent(s) become ineligible for University benefits.

Employee Benefits Enrollment Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Enroll in UK health, dental, and vision insurance. You must download and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Employee Benefits Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Enroll in UK health, dental, and vision insurance. You must download and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Health Savings Account Amendment Form 2020-2021

Plan year July 1, 2020 through June 30, 2021

Use this form at any time during the year to start, stop, increase, or decrease the amount you contribute to you HSA.

Health Savings Account Enrollment Form 2019-20

Plan year July 1, 2019 through June 30, 2020

Use this form if you are enrolling in the UK Saver HSA health plan and would like to make additional employee contributions.You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Health Savings Account Enrollment Form 2020-21

Plan year July 1, 2020 through June 30, 2021

Use this form if you are enrolling in the UK Saver HSA health plan and would like to make additional employee contributions. This also includes the option to open a limited flexible spending account. You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Wellness

Form Description
Chair Massage Release Form

This form is required for your participation in Therapeutic Chair Massages offered by UK Health & Wellness. Please fill out and bring the completed form with you the day of your massage. Please arrive 5 minutes before your appointment. 

General Health & Wellness Waiver

This form is required for participation in most Health & Wellness programs and events.

Employment

Form Description
Direct Deposit

Direct deposit is mandatory for all UK employees. New Student employees should fill out this direct deposit form, attach a voided check and return to the department of hire. Completed direct deposit forms may also be sent directly to:

UK Payroll
340 Peterson Service Bldg.
0005

Employee Separation Sheet Form

Departments/supervisors should complete this form when an employee leaves employment with the University.

Staff Appointment / Change in Status

Elder Care

Form Description
Elder Care Lunch & Learn Registration


UK Elder Care is pleased to present the 2014 Lunch & Learn Series. Bring your lunch and learn about important topics. Each free session requires preregistration and is open to UK faculty, staff, retirees, spouses, and sponsored dependents. Space is limited. Use the online form to register.

Request Resources for Elder Care Caregiver

Thank you for your interest in receiving Caregiving Resources via the UK Elder Care Office.  Please complete the form.

Employee Relations

Form Description
Emergency Paid Sick Leave request form

Use this form to request Emergency Paid Sick Leave, available April 1, 2020, through December 31, 2020, related to the COVID-19 public health crisis.

Employee Grievance Form
Organization Unit Change Form

Use this form to create new organizational units and to change existing information concerning organizational units in SAP

Position Reporting Change Form

Use this form to change the position reporting information in SAP.

Records

Form Description
Employee Records Signature Release Form

Complete this form to approve the release of your UK employment information.

Salary Release Authorization Form

To release salary information for verifications of employment (VOE), use this form. The information cannot be provided until this form (or that of the requesting organization) has been signed and submitted. Note that businesses and non-government agencies will also be required to pre-pay a $30 fee, and a VOE cannot be completed until confirmation that the fee has been paid.

Hiring Officials

Form Description
End of Orientation Form

Use this form to evaluate new or transferred employees performance after 90 days of employment.

Memo of Understanding for Hiring Officials

Hiring officials that are in the process of hiring anyone as it pertains to Policy 17.0: HR Temporary and Student Employment Services should fill out this form.

Salary Recommendation Form (Staff)
Salary Recommendation Form - Campus Instructions
Salary Recommendation Form - Healthcare Instructions
STEPS Employee Request Form
STEPS Performance Evaluation

At the conclusion of a STEPS temporary employee's assignment, please fill out this performance evaluation. It is important to us when considering future assignments for each employee. Please complete and return this form to the Temporary Employment office by faxing to 257-­7464 or send the original via campus mail to:

Temporary Employment, 103 Scovell Hall, 0064.

Student Employee Request Form

Use this form to submit a request for posting a new Student Employee position.

Tell Us if you Hired a Student!

If you have hired a Student Employee through UK, we want to know about it! Student Employment at the University of Kentucky is funded in part by a grant, which stipulates that we must collect hiring information. Please help us keep this great service FREE by supplying the following information when you have hired a Student Employment referral. Thank you.

Temporary Disability Leave/Retirement Conversion Form

Use this form to create a new position or redefine the duties of a current position. Once completed all required signatures must be obtained prior to submitting the document to the Compensation Department.

Temporary Employment Evaluation

This form is used by employers to evaluate the performance of a temporary employee.

Unemployment

Form Description
Exit Checklist - Campus

Contact (859) 257-8758 for more information.

Exit Interview Survey

The exit interview is an opportunity to obtain valuable information about perceptions, frustrations and areas in need of improvement. The Exit Interview Survey is designed to gather information in a consistent, non-threatening manner. Although written in survey format, each department is encouraged to identify a neutral third party to meet one on one with the employee and gather information orally. The exit interview is voluntary but strongly encouraged.

Compensation

Form Description
Flex Leave Form

Use this form when an employee is being placed in an approved flex leave position. This form should be forwarded to the Compensation Department along with the PAR prior to the employee being placed on flex leave.

Independent Contractor: Worker Status Evaluation Form

This form must be completed by department administrators prior to retaining any individual to provide services and submitted to HR as explained in BPM E-7-3.

Internal Overload Form

Form to be completed for approval of assignment outside exempt employee's main department/work assignment.

Job Analysis Questionnaire (JAQ)

This is a paper version of the official form which resides in IES. Use this as a tool to pass around within your department while editing it. Then once a final version is completed, it can be entered into IES (Position Management).

Worker Status Evaluation Form

Before retaining individuals to provide services to the University of Kentucky, this form must be completed and returned to HR Compensation. Generally, this form is required each time an individual is retained.

Form Description
FlexWork Request Form

Use this form to submit an online request for flexible work schedule. A copy of the submitted form goes to you, your supervisor, and the Director of WorkLife at UK. Together you will work out the best flexible workplace arrangement.

Submit a TeleWork Request Online


Use this form to submit an online request for Telework schedule. A copy of the submitted form goes to you, your supervisor, and the Director of WorkLife at UK. Together you will work out the best Telework workplace arrangement.

Family Medical Leave

Form Description
FML Notification Memo
Request for Family and Medical Leave

Campus employees: Submit forms to Phillip Neeley-Morrison by emailing phillip.neeley@uky.edu or faxing to 859-257-1679.

UK HealthCare employees: Submit forms to Lindsey Powell by emailing lindseyhpowell@uky.edu or faxing to 859-257-2010.

Request for Military Family Leave Form

Request for Family and Medical Leave - Serious injury or illness of current servicemember for Military Family Leave

Request for Qualifying Exigency for Military Family Leave

Request for Family and Medical Leave - Qualifying Exigency for Military Family Leave

Request for Veteran for Military Caregiver Leave

Resources for Parents

Form Description
Grogan's Breast Pump Rental Form

Use this form to apply for free rental of a breastpump from Grogan's Medical Supply, as part of UK's support of lactation in the workplace.

Little Cats Guide

Printable guide for UK parents preparing for leave, finding child care, support offered by UK and everything you need to know about Family Medical Leave.

Prescription

Form Description
Mail order form – active employees and under 65 retirees
Mail order form – Medicare retirees
Manual claim form for employees and retirees under age 65

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Manual claim form for retirees age 65 and over (Medicare Advantage Plan)

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Medicare Rx EOC 2020
Prescription formulary (active employees and under 65 retirees)

Prescription formularies for UK health plan members on either HMO, PPO, RHP, EPO, Saver or Indemnity plans.

If you have any questions, call our pharmacists with the Know Your Rx Coalition at (859) 218-5979 or (855) 218-5979 for information specific to your medication, formulary and costs.

Saveon SP Non-Essential Coverage Specialty Drug List
UK Medicare Part D Prescription Formulary 2020

Be

Form Description
Nourishing Holiday By Design Exercise

Download this form to accompany Amy Rodquist-Kodet's "Creating A Nourishing Holiday By Design" presentation.

Shared Leave Pool

Form Description
Staff Shared Leave Application

This form allows UK Staff to apply for use of the Staff Shared Leave Pool allocation.

Temporary Employment

Form Description
STEPS Timesheet

Fill out this form using the instructions on the STEPS Timesheet Guide page

SUBMISSION INSTRUCTIONS

Unless handled by the department, it is the temporary employee’s responsibility to submit a copy of  his/her signed timesheet reporting all hours worked to the Temporary Employment office at 103  Scovell Hall, or fax it to 257-7464, or email a PDF file to TempEmpTimesheets@uky.edu by noon on the dates listed below. Temporary Employees are not permitted to deliver original timesheets. Original timesheets need to be submitted by the supervisor to the Temporary Employment Office via campus mail or personal delivery by payday Friday. 

 

Temporary Employees - Address Change
Temporary Employment Timesheet

This form is used by temporary employees to record their work hours for a given pay period.

Student Employment

Form Description
Tell Us When You're Hired

Student Employment at the University of Kentucky is funded in part by a grant, which stipulates that we must collect hiring information. Please help us keep this great service FREE by supplying the information when you are hired.

Career Development

Form Description
UK Career Development Contact Form

UK Employees: Contact us to get started on the path of Career Development.

UK Career Development Registration Form

This intake form will provide the Career Development office with the preliminary information they need to better assist you for your Career Develompent appointment.