Forms

Insurance forms

• Dental Claim Form
• Flex Medical Claim Form
• Flex Dependent Care Reimbursement Form
• AFLAC Accident Claim Form
• AFLAC Hospital Indemnity Claim Form
• AFLAC Initial Disability Claim Form (Short-Term Disability)
• Lincoln Financial Beneficiary Change
• Lincoln Financial Continuation of Life Insurance Coverage Enrollment Form

 

Life Events

• Domestic Partner Benefits Policy/Affidavit and Notice of Termination of Domestic Partnership
• Employee Information Change Form (Name and/or Address)
• Employee Request for Leave under the Family Medical Leave Act (FMLA)
• FMLA – Medical Certification Forms and Submission Portal
• Elon Vacation Donation Request Form

 

New Hire Forms

Supervisors and new hires can access more information on the New Hires page.

• New Employee Information Form
• Federal Tax Form (W-4)
• State Tax Form (NC-4EZ)
• State Tax Form (NC-4)
• Consent to Receive Electronic Notices
• Form I-9
• List of Acceptable I-9 Documents
• Hepatitis B Immunization Consent/Refusal Form

Retiring/Exiting Elon

• Exit Interview Questionnaire
• Inclusion in Elon’s online retiree fac/staff directory
• Lincoln Life Conversion & Enrollment Form
• Proof of Health Insurance – Medicare Part B

• Supplemental Insurance for Retirees – Enrollment form
• Elon Retiree Benefits Guide

 

Retirement Plan – TIAA (403B)

• TIAA – Defined Contribution Plan Waiting Period Waiver Form
• TIAA – Beneficiary Form
• TIAA – On-Line Application
• TIAA – Elon Salary Reduction Agreement for Full-Time Faculty/Staff
• TIAA – Elon Salary Reduction Agreement for Part-Time Staff and Adjuncts Summary Plan Descriptions

 

Supervisor

• Personnel Action Request Form
• Position Description Form
• Significant Occurrence Form
• Student Worker Position Description Form
• Introductory Appraisal Form (fillable)

Hiring

• • Key requests are made via FIXit.
  • Non-employee Information Form
  • Position Description Form
  • Reference Check Form