Forms
Benefits Rates
- Rate Sheet for 12 Months
- Rate Sheet for 12 Months - Part Time
- Rate Sheet for 9 Months
- Rate Sheet for 9 Months - Part Time
- Rate Sheet for 10 Months
- Rate Sheet for 10 Months - Part Time
- Rate Sheet for 10.5 Months
- Rate Sheet for 10.5 Months - Part Time
- Rate Sheet for Retirees
Health Insurance
- Medical Plans Comparison Summary
- UMR Enrollment Form
- UMR Transition of Care (Previous QualChoice Participants Only)
- QualChoice Medical Services Claim
- Prescription Drug Formulary
- Prescription Benefit Summary
- Prescription Claim Form
- Weight Loss Program - Physician Attestation Form
- Weight Loss Program - Reimbursement Form
Dental Insurance
Vision Insurance
- Superior Vision Enrollment Form
- Vision Benefit Comparison Summary
- Superior Vision Amendment-Dependent Children Age Limits
Flexible Benefit Plan
FSA
- Dependent Care Reimbursement Claim Form
- Health Care Reimbursement Claim Form
- FSA Direct Deposit Informational Flier
- Direct Deposit Authorization Form
Summary of Plan Documents (SPD)
- Retiree Basic Life Group Insurance Plan
- University of Arkansas Retirement Plan
- Optional and Dependent Life Group Insurance Plan
- Point of Service Benefit Plan
- Classic Benefit Plan
- Delta Benefit Plan
- Basic and Optional Long Term Disability Group Insurance
- Basic Life Group Insurance Plan
- Accidental Death and Dismemberment
Retirement Plan
- Retirement Plan Acknowledgement Form
- Retirement Plan Options
- Salary Deferral Agreement (Before Tax Deduction/Roth)
- Salary Deduction Agreement (After Tax Deduction)
- Fidelity Investments - Beneficiary Designation Form
Worker Compensation
Employee Forms
- Form N (Employee Notice of Injury)
- Form PECD 1 (Employee Report of Accident)
- Mileage Form
- Form S (Supplemental Report-Change in Work Status)
Employer Forms
Classification/Compensation
- Applicant Summary Sheet ( OPM 081 )
- Concurrent Employment Request Form
- Concurrent Employment Request Form Instructions
- Hourly Position Classification Form
- Personnel Action Form (PAF)
- Personnel Action Form Instructions
- Stipend Classification Worksheet
- Stipend Procedures
Payroll
- Visit http://ualr.edu/payroll for other payroll forms.
General
- Affirmative Action Review Form
- Essential Job Function (ADA) Form
- Probational Evaluation Form
- Employee Counseling Form
- Classified Employee Performance Evaluation
- Classified Employee Performance Evaluation Instructions
- Classified Employee Performance Evaluation - Quick Reference Guide
- Classified Employee Disciplinary Notice Form
- Classified Search Disposition Form
- Conflict of Interest
- Departmental Required Documentation
- Faculty/Non-classified Search Disposition Form
- ID Request Form
- Travel Guidelines - HR Guest of State
- Personnel Requisition Form
- Leave Without Pay Form
- ADA Accommodation Instructions
- ADA Accommodation Form
- Name/Address Change
Updated 4.16.2013