Beneficiary Designation

(for your Group Life Insurance)

• Lincoln Financial Group Beneficiary Designation Form

Benefit Changes

(Qualifying Life Events)

• Request to Change Benefit Elections

• Medical Expense Claim Form

Dental Plan Forms

• United Concordia Dental Enrollment Form
• United Concordia Claim Form

• Affidavit of Common Law Marriage - Employee
• Affidavit of Common Law Marriage - Spouse
• Affidavit of Domestic Partnership
• Affidavit of Tax Qualified Dependent
• Statement of Termination of a Domestic Partnership
• Tax Information on Health Benefits for Domestic Partners

• Provost's Office FML Accommodation Form for Faculty
• Lehigh University Faculty and Staff FML Request Form
• FMLA Certification of Health Care Provider

Flexible Spending Accounts

Reimbursement Forms

Expense Information

• Health Care FSA Reimbursemnt Form
• Dependent Care FSA Reimbursement Form
• Ceridian FSA Ineligible and Eligible Expenses

• Leave of Absence Form

• Medical Enrollment/Change Form

• Home Buying Program Brochure
• Mortgage Payment Form
• Promissory Note

• Personal Information Change Form (Word)
• Personal Information Change Form (pdf)

• Medco Mail Order Form
• Medco Order Refill Request Form
• Medco Coordination of Benefits/Direct Claim Form

• For Employees
• For Supervisors
• Authorization For Release Of Information
• Attending Physician's Statement

• 2013-14 Tuition Cash Grant Application (pdf)
• 2013-14 Tuition Cash Grant Application (e-form)
• 2013-14 Tuition Cash Grant Fact Sheet (pdf)
• Statement of Dependency Form (pdf)

• Davis Vision Claim Form

• 2013 Salary Reduction Agreement (Word)
• 2013 Salary Reduction Agreement (Form)
• 2013 Salary Reduction Agreement (pdf)

• Request for Reasonable Accommodation
• Medical Information Request and Verification Form

• Form for Members of Informal Network to report on resolution of cases to Harassment Policy Officer

• Problem Solving Process Form

• Apply through the online Jobs@Lehigh site

• Faculty Employment Request Form
• Staff Employment Request Form (pdf)
• Staff Employment Request Form (word)

• Form I-9, Employment Eligibility Verification

• Request for Reference and Release
• Employee's Separation Information Sheet
• Supervisor's Separation Plan Checklist

• Employees Transferring Within Lehigh
• Employees Leaving Lehigh

• Nomination Form (word)

• Tradition of Excellence Nomination Form (pdf)

• Extra Duty Form (pdf)
• Extra Duty Form (word)

• On-Campus Consulting Form (pdf)
• On-Campus Consulting Form (word)

• How to access your position description

• Position Re-evaluation Request Form (word)
• Position Re-evaluation Request Form (pdf)

• Staff Request to Abstain from Deferred Pay Program

• Temporary Bonus Request Form (word)
• Temporary Bonus Request Form (pdf)

• Predated Timesheets (nonexempt and exempt staff)
• Special Rates Timesheets

• Blue Jean Bash 2012 Announcement and Registration

• April 2013 HealthScan Registration (word)
• April 2013 HealthScan Registration (pdf)

• BEST Program Registration Form (pdf)
• BEST Program Registration Form (word)

• GPS Performance Management Resources
• Performance Improvement Plan Form
• Self-Appraisal Preparation Form
• Success Factor Worksheet - Core
• Success Factor Worksheet - Managerial

• Make the Most of Training - Employees
• Make the Most of Training - Supervisors
• Training Registration Form
• Workplace Learning Calendar

• Equal Employment Opportunity
• Fair Labor Standards Act
• Family Medical Leave Act
• Government Contracts
• OSHA Job Safety and Health
• Polygraph Protection
• Uniformed Services Employment Rights

• Child Labor Law (Employment of Minors)
• Equal Pay Law
• Human Relations Act
• Minimum Wage Law
• Unemployment Compensation Notice