HR Forms
Appointment Action Forms
Helpful Tips: this document explains how to fill and sign PDF forms electonically.
PR Assist
Adjunct Management System
Graduate Assistant Forms
Reasonable Accommodation Policy and Forms
- Reasonable Accommodations Policy
- Reasonable Accommodations Request Form
- Reasonable Accommodations – Health Care Provider Assessment Form
Multiple Position Policy and Forms
- Multiple Position Report Form For Full-Time Faculty
- Multiple Position Memo
- Multiple Position Reporting Form for Non-Teaching Instructional Staff
- External Employment Reporting Form(Classified Staff)
Fall 2022 Open Enrollment Annual Transfer Period for Plan Year 2023
To change health insurance plans or add or drop health Insurance plan riders is November 1 through November 30, 2022. The change is effective in the first full pay period in January 2023.
FSA programs; DeCAP, HCFSA and Buy Out Waiver plans is October 17 through November 18, 2022. These changes are effective January 1, 2023.
The Dependent Care Assistance Program (DeCAP): $500 minimum, $5000 maximum
Health Care Flexible Spending Account HCFSA: $260 minimum, $2850 maximum
Buy-Out Waiver Program: $500 Individual, $1000 Family
CUNY Castraphic Sick Leave Bank is November 1, through November 30, 2022
- Flexible Spending Accounts Manual
- FSA Enrollment/Change Form
- DeCAP Claim Form
- HCFSA Claim Form
- MSC Health Benefits Buy-Out Waiver
- Catastrophic Sick Leave Bank Program Information
- Catastrophic Sick Leave Bank Program – Application to Donate Sick Leave
- Catastrophic Sick Leave Bank Program – Application to Receive Sick Leave
- Catastrophic Sick Leave Bank Program – Application to Change Donation or Withdraw
- City of New York Health Benefits Application
- PSC Enrollment Form
- PSC Change of Status From
Benefits Forms
- My Benefits at a Glance Form
- Tuition Waiver Request Form
- CUNY Employee Tuition Waiver Form
- Welfare Fund Enrollment Form
- Flexible Spending Accounts Enrollment/Change Form
- Health Benefits Buy-Out Waiver Form
- CCA@YourService Employee Assistance Program
- Domestic Partnership Registration for Bereavement Leave
- FFCRA (Families First Coronavirus Response Act)
- Emergency Family Medical Leave and Expansion Act Attestation & Request form
- Emergency Paid Leave Attestation & Request Form
- Family Medical Leave Act (FMLA) Policy and Information
- Family Medical Leave Act (FMLA) Policy
- Notice of Eligibility and Rights and Responsibilities
- FMLA Request Form
- Designation Notice
- Fitness for Duty Certification
- Certification of Family Relationship Form
- Certification of Health Care Provider (HCP) for Employee's Serious Health Condition
- Certification of Health Care Provider (HCP) for Family Member's Serious Health Condition
- Certification for Serious Injury or Illness of a Current Service Member - Military Family Leave
- Certification for Serious Injury or Illness of a Veteran - Military Caregiver Leave
- Certification of Qualifying Exigency for Military Family Leave
- Non-FMLA Medical Leave Forms
- Fellowship Leave Application
- Paid Parental Leave
- Paid Parental Leave Information
- Paid Parental Leave Application Form
- Paid Parental Leave Policy
- Revised Paid Parental Leave Policy Memo
- Unpaid Child Care Leave Form
- Paid Family Leave Guidelines for PSC
- SC-PFL-Bonding Application
- SC-PFL-Care For Family Application
- SC-PFL-Military Application
- General Employment Application
- Instructions for the Addition of Domestic Partners to City Health Plan Coverage
- Professional Development Funds Application (HEO & CLT Title series)
- Special Leave of Absence Without Pay
- Partial Leave With Partial Pay
- Special Leave for Child Care (Unpaid) Application
- CUNY Phased Retirement Professional Staff Application
- CUNY Phased Retirement Faculty Application
- Retirement Leave of Absence (Instructional Staff)
- Scholar Incentive Award Application
- Aetna Medical Claim Form
- TRS Certification of Employment Under Section 212 / IA8 Form
- Certification of Employment Under Section 212 for Members of the Optional Retirement Program
- Dental Claim Form (DC 37)
- Dental Claim Form: Guardian (PSC-CUNY)
- Dental Enrollment Form: Delta Dental (PSC-CUNY)
- Dental Transfer Form: Delta Dental (PSC-CUNY)
- GHI Health Insurance Claim Form HCFA-1500
- New Employee HIP HMO Opt-Out Request Form
- Long-Term Disability Benefits Claim Packet (Instructional Staff)
- PSC-CUNY Welfare Fund Optical Reimbursement Form
- Retiree Change of Address Form
- Short-term Disability Benefit Claim Form (DC 37)
- TIAA-CREF Contributions on Multiple Positions Form
- NYS Young Adult Coverage Age 29 Forms
- CUNY Dedicated Sick Leave Policy
- Application to Dedicated Leave
- Application to Receive Dedicated Leave
- HEO CLT Application and Guidelines (Professional Development)
- Classified Staff Agency Shope Fee Authorization Form
- PSC Agency Shop Fee Authorization Form
- Bargaining Unit Exclusion Form for Instructional Staff
- DC37 Union Membership Form
Transit Forms
- Edenred Transit Benefit Plan Application(City)
- Edenred Transit Benefit Plan Application(State)
- Edenred Park-N-Ride Plans Form(City)
- Edenred Park-N-Ride Plans Form(State)
Workers' Compensation Forms
- DP-2002 - Employee Selection of Option
- WCD-201 - Supervisor's Report of an Injury/Illness
- WCD-23 -Employee Statement of Accident
- WCD-26 - Witness Reporting of Injury
Employement Verification Forms
Exempt and Non-Exempt Time Sheets
- Exempt Timesheet
- Non-Exempt Timesheet
- Overtime Payment Request (Exempt)
- Overtime Payment Request (Non-Exempt)
- HEO Compensatory Time Agreement
Payroll Forms
- Adjunct Timesheets
- Advance Earned Income Tax Credit
- Direct Deposit of Salary Enrollment Form (State Payroll)
- Direct Deposit of Salary Enrollment Form (City Payroll)
- Form 8233 (Non Resident Alien Tax Exemption Form)
- Form W-4 ( Federal Tax Withholding Form)
- IT-2104 (Employee's Withholding Allowance Certificate)
- IT-2104 E (Certificate of Exemption from Withholding)
- Time Attendance Report
Performance Management Forms
- Classified Managerial Performance Evaluation (Managerial)
- Classified Employee Performance Evaluation (Non managerial)
(PDF format) (Word format) - HEO Performance Evaluation Memorandum (PDF format)
(Word format) 
*** Forms updated as of Jan-2011 (for Word format, save the file to your computer and edit from Word not Internet Explorer.) - CLT Evaluation Memorandum Form
- (PDF format) (Word format)
- CLT Evaluation Instructions
- Campus Peace Officer Performance Appraisal
HEO Labor Management
Miscellaneous
- Approved Foreign Education Evaluation Services
- Authorization for Release of Information
- Budget Authorization Form
- Application form for Library Reassignment Leaves
- Change of Address
- Classified Service Merit Guidelines (Managerial)
- Classified Service Merit Guidelines (Non-managerial)
- E-Mail Account Request Form (from Hunter ICIT Web Site)
- Emergency Evacuation Form
- Employee Preferred Name Change Request Form
- Employee Request for Name and Gender Changes Memo
- Employee Request for Gender Change Request Form
- Gittleson Intra-College Transfer
- History of Service
- Honoraria Memo to Faculty & Staff
- Honoraria Reporting Filing Guidelines
- Honoraria Reporting Form- Faculty
- Honoraria Reporting Form- Non Faculty
- Hourly Instructional Staff Report of Absences
- I-9 Form (Employee Eligibility Verification)
- IT Security Policy
- Managerial Uniform Allowance Application
- Non Tax Levy Role Assignment Form
- Non-Teaching Instructional Staff Action Form (HEO, CLT, RA Title Series Green Form)
- Request for Placement on Transfer Roster (Competitive Titles)
- Request for Placement on Transfer Roster (Non-Competitive Titles)
- Request for Placement on Transfer Roster. (Skilled Trade Titles)
- Request for Reinstatement
- 2017 Prepaid Legal Services Benefit - District Council 37
- Person of Interest (POI) Data Form
- Person of Interest (POI) Renewal Form