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Kansas State University

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Form directions and/or additional information are provided in the Instructions or Information Column or within the form.

Technical Support for Forms:
Kathy Kugle (785) 532-1885
or email kkugle@ksu.edu

Forms

Division of Human Resources
Kansas State University
103 Edwards Hall
Manhattan, KS 66506-4801
785-532-6277
785-532-6095 (fax)
8 a.m. - 5 p.m. (CST)
Contact HR

Classified Staff Forms

Refer to Classified Transactions for instructions on personnel transactions. Refer to the summary of benefits for staff for additional information on benefits entitlements.

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Alphabetical List of Classified Staff Forms
FORMS by NameDatedInstructions
or Information
Versions
Above Step Request (PER-3) 8/2011 PPM 4450.30 RTF Word PDF  
Accident/Injury Report (PER-17) (Workers' Compensation) (do not use after April 30, 2014) 02/2010 PPM 4820.100 RTF Word PDF  
Accident Report (1101-A) (Workers' Compensation) (new form can be used now and will be the only form accepted starting May 1, 2014) 10/2013 PPM 4820.100     PDF  
Administrative Leave Reporting 6/2003 PPM 4860 RTF Word PDF  
Advance Leave Agreement PER-60 10/2009 Leave Advancement Policy RTF Word PDF  
Affirmative Action Classified Selection Report (PER-10)   Affirmative Action-Classified Recruitment     PDF  
Agency Payroll Deduction Authorization 5/2007 Agency Payroll Deductions RTF Word PDF  
Agreement of Understanding for Overlapping Appointment (PER-28) 10/2004 Military Service Policy RTF Word PDF  
Agreement for Limited Term Appointment (PER-43) 10/2004 PPM 4460.40 RTF Word PDF  
Agreement for Reimbursement of Moving Expenses(DA-22) 11/1998 Moving Expenses RTF Word PDF  
Agreement for School Employee Appointment (PER-21) 08/2013   RTF Word PDF  
Annual Review of Classified Position Descriptions (PER-26) 07/2008 PPM 4210 RTF Word PDF  
Application for Tuition Assistance 2013/2014       PDF  
Application for Tuition Assistance - Dependents/Spouses 2013/2014 Dependent/spouse grant     PDF  
Appointment Form (PER-38) 07/2013 Unclassified
Classified
RTF Word PDF  
Authorization to Release Information 10/2004 PPM 4010 RTF Word PDF  
Background Check Request Form (PER-59) 01/2013 Background Checks
Background Check Form Instructions
    PDF  
Beneficiary Basic/Optional Life insurance KPERS employees (KPERS 7/99) 04/2011 PPM 4820.60     PDF  
Beneficiary Basic/Optional Life Insurance Board of Regents employees (KPERS 7/99A) 6/2010 PPM 4820.60     PDF  
Beneficiary TEA optional life insurance Met Life 07/2001 Included
TEA Life Insurance
    PDF  
Change or Separation Form (PER-39) 04/2014 Classified RTF Word PDF  
K-State Classified Award of Excellence Nomination Form   Guidelines RTF Word PDF  
Departmental Employee of the Year Award & Recognition Program Monetary Award Payment Form (PER-7) 11/2009 Guidelines RTF Word PDF  
Direct Deposit of Employee Pay (PER-58) 12/2010 Instructions
Information
RTF Word PDF  
Educational Authorization Form (PER-25) 5/1998 PPM 4870.20 RTF Word PDF  
Employee Conference Form   PPM 4020     PDF  
Employee Separation Checklist (PER-24) 06/2011 Classified Separations
Unclassified Separations
PPM 4950
RTF Word PDF  
Employment Application (Online)   Classified Employment        
Employment Eligibility Verification (I-9) 03/2013 Included     PDF  
Exit Interview for Classified Employees (PER-16) 10/2013 PPM 4950 RTF Word PDF  
Flexible Spending Account Enrollment/Change Form 2014 Flexible Spending Accounts     PDF 
FMLA Certification of Health Care Provider for Employee's Serious Health Condition   FMLA Dept. of Labor     PDF  
FMLA Certification of Health Care Provider for Family Member's Serious Health Condition   FMLA Dept. of Labor     PDF  
FMLA Notice of Eligibility and Rights & Responsibilities   FMLA Dept. of Labor     PDF  
FMLA Designation Notice   FMLA Dept. of Labor     PDF  
FMLA Certification of Qualifying Exigency For Military Family Leave   FMLA Dept. of Labor     PDF  
FMLA Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave   FMLA Dept. of Labor     PDF  
KSU Foreign National Tax Information Form (PER-15) 04/2014 Visa Classifications RTF Word PDF  
Health Care Selection Form   Health Insurance     PDF  
Health Insurance Affidavit of Common Law Marriage 2013 Health Insurance     PDF  
Health Insurance Application for Coverage of Handicapped Dependent Child 2013 Health Insurance     PDF  
Health Insurance Change Form 2013 Health Insurance     PDF  
Health Insurance Communication Form 2013 Health Insurance     PDF  
Health Insurance Dependent Grandchild Affidavit 2013 Health Insurance     PDF  
Health Insurance Enrollment Form 2014 Health Insurance     PDF  
HIPAA- Authorization Form for Release of Medical Information 2013 Health Insurance     PDF  
Health Savings Account Enrollment & Change Form 2013 Health Insurance     PDF  
HealthyKIDS Application   Information       Online
Holiday Emergency Overtime Reporting 6/2003 PPM 4450.70 RTF Word PDF  
HRIS/PeopleSoft Access Form   Instructions (pdf)
HRIS Roles
RTF Word PDF  
NEW Online HRIS Access Termination Form           Online
Initial Screening of Candidates Prior to Interview (AA-28)   Instructions RTF Word PDF Excel
Intellectual Property Agreement   Information RTF Word PDF  
Investment Agreement - Voluntary Pre-Tax Retirement Plan (PER-19) 06/2012 PPM 4810.80     PDF  
Investment Agreement - Voluntary Roth After-Tax Retirement Plan (PER-19R) 06/2012 PPM 4810.80     PDF  
Kansas Employee's Withholding Allowance Certificate (K-4) 09/2007 Information     PDF  
Learning Quest Direct Deposit Change or Enrollment Form   Information     PDF  
Leave Balance Correction Sheet (PER-9) 10/2013 Information RTF Word PDF  
Leave Record 05/2013
for FY 2014
Instructions RTF Word PDF Excel
Leave Record 03/2014
for FY 2015
Instructions RTF Word PDF Excel
Leave Request-Hourly (Non-Exempt) Employees   Instructions       Online
Leave Request-Salaried (Exempt) Faculty and Staff   Instructions       Online
Life Insurance Beneficiary Designation Form (TEA) 07/2001 Included
TEA Life Insurance
    PDF  
Life Insurance Enrollment Form (TEA)   TEA Life Insurance     PDF  
Life Insurance Request to Change or Cancel Insurance Policy Form (TEA)   TEA Life Insurance     PDF  
Life Insurance Statement of Health (TEA)   TEA Life Insurance     PDF  
Mileage Reimbursement Form (Workers' Compensation)   Information RTF Word PDF  
New Course Data Sheet 12/2008 Instructions (PDF) RTF Word PDF  
New Employee Orientation Forms Checklist 11/2001 PPM 4070 RTF Word PDF  
Non-Resident Alien Forms   Non-Resident Alien Employment        
Notification of Retirement (PER-37) 6/2009 PPM 4810 RTF Word PDF  
Optional Group Life Enrollment Form   Optional Life     PDF  
Optional Group Life Reduction/Cancellation Form 09/2003 Optional Life     PDF  
Orientation Checklist 08/2012 PPM 4070 RTF Word PDF  
Orientation Forms Checklist 11/2001 PPM 4070 RTF Word PDF  
Overtime Compensation Agreement for Non-Exempt Employees (PER-34) 02/2007 PPM 4220.70 RTF Word PDF  
Paycheck Stop Payment Request (DA-6P) 05/2006 Information     PDF Excel
Payroll Transfer Form (PER-44) 04/2009 Instructions     PDF Excel
Performance Management Process Form 2012-2013 Performance Management Process
Instructions
RTF Word PDF  
Performance Management Process Form (DA-244) 2013-2014 Performance Management Process
Instructions
RTF Word PDF  
PMP Coaching & Feedback Form 2013-2014 Performance Management Process RTF Word PDF  
PMP Mid-Review Discussion Form 2013-2014 Performance Management Process RTF Word PDF  
Position Data Sheet (PER-36) 07/2013 Unclassified
Classified
RTF Word PDF  
Position Description (Classified) (DA 281-2 Special) 2/2014 PPM 4210
Position Descriptions Checklist
RTF Word PDF  
Prescription Claim Form   Prescription Drug Program     PDF  
Request for Certified Names (PER-5) 11/2012 Instructions
Department Recruitment Procedures
    PDF  
Retirement Notification (PER-37) 6/2009 PPM 4810 RTF Word PDF  
Shared Leave Donation Form (PER-64D) 4/2012 Instructions RTF Word PDF  
Shared Leave Request Form (PER-64A&B) 3/2013 Instructions RTF Word PDF  
Substance Abuse Policy Affirmation Form 5/2007 Information RTF Word PDF  
Tax Clearance Information Form for Candidates and New Hires (DA-2004a) 05/2004 Information     PDF  
TEA Life Beneficiary Designation Form 07/2001 Included
TEA Life Insurance
    PDF  
TEA Life Insurance Enrollment Form   TEA Life Insurance     PDF  
TEA Life Insurance Request to Change or Cancel Insurance Policy Form   TEA Life Insurance     PDF  
TEA Life Insurance Statement of Health   TEA Life Insurance     PDF  
(Summer) Tuition Assistance Application (2013) 2013       PDF  
Tuition Assistance Application 2013/2014       PDF  
Tuition Assistance Application - Dependents/Spouses 2013/2014 Dependent/spouse grant     PDF  
Workers' Compensation Accident/Injury Report (PER-17) 02/2010 PPM 4820.100 RTF Word PDF  
Workers' Compensation Accident Report (1101-A) 10/2013 PPM 4820.100     PDF  
Workers' Compensation Mileage Reimbursement Form   Information RTF Word PDF  
W-4 Employee's Withholding Allowance Certificate
OR Update online in Employee Self Service
2014 Included
Information
    PDF  
Withholding form
Kansas Employee's Withholding Allowance Certificate (K-4)
09/2007 Information     PDF  
W-9 Request for Taxpayer Identification Number and Certification 8/2013 Included     PDF