Retirement Manager

Health, Dental, and Vision Care Enrollment Form

Learning & Organization Development Class Registration

Federal & State Tax Withholding Forms

Report a Work-Related Accident, Injury, or Illness

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Health Insurance Web Site
Dental Insurance Web Site
Vision Care Web Site

Health, Dental, and Vision Care Enrollment Form

Health Claim Form - BlueCross BlueShield

Health Claim Form - WellPath Select

Ameritas Group Dental Claim Form

Duke Vision Plan Claim Form (for out-of-network providers)

Merck-Medco Claim Form (Pharmacy Benefits)

Merck-Medco Mail Order Form (Pharmacy Benefits)

Disability Web Site

Hartford Personal Health Statement

Voluntary Disability Enrollment Form

Educational Benefits Web Site

Employee Tuition Assistance Program Application (effective January 1, 2007)

Duke University Children's Tuition Grant Program Application

Educational Assistance Certification Form
(not open to new enrollees after December 31, 2006)

Employee Occupational Health Web Site

Tuberculosis Screening Form

Tuberculosis Questionnaire

Placement Health Review

Health Review for Animal Handlers

Certification of Health Care Provider (FMLA/Kiel Program Form)

Life Insurance Web Site

Basic Life Insurance Beneficiary Designation Form

Personal Accident Insurance - Enrollment/Beneficiary Form

Supplemental Life Insurance Customer Service Request Form

Supplemental Life Insurance Enrollment Form

Universal Life Insurance Application for Payroll Deduction

Reimbursement Web Site

Reimbursement Accounts Change Form

Health Care Reimbursement Account Claim Form

Dependent Care Reimbursement Account Claim Form

Retirement Web Site

Retirement Plan Enrollment Kit

Retirement Plan Contribution Change Form (Biweekly Employees)

Retirement Plan Contribution Change Form (Monthly Employees)

Request for Benefits Estimate - Employees' Retirement Plan

AIG Retirement Enrollment Application

Fidelity Enrollment Application

Scudder Enrollment Application

TIAA-CREF Enrollment Application

Vanguard Enrollment Application

Same Sex Spousal Equivalency

Same Sex Spousal Equivalent Benefits Web Site

Affidavit of Same-Sex Spousal Equivalent Relationship

Affidavit Terminating a Same-Sex Spousal Equivalent Relationship

Work Absences

Work Absences Web Site

Kiel Program Application Form

Kiel Program Donor Form

Certification of Health Care Provider (FMLA/Kiel Program Form)

Leave of Absence Request Form

Payroll Leave of Absence Form

Paid Parental Leave Request: Primary Caregiver Affidavit

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Request for Duke Personnel Data

Request for Duke Personnel Data Form

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Duke Jobs web site (external candidates)

Duke Jobs web site (Duke employees)

Duke Jobs web site (nursing candidates)

Hire/Termination

Background Check/Candidate Certification Form

Confidentiality Agreement

Direct Deposit Authorization Agreement

Foreign National Form

I9 - U.S. Employment Eligibility Verification Form

Student Payroll Form

Supplemental Pay Form

Telephone Reference Check

Tax

NC-4 - Employee's Withholding Allowance Form

W-4 - Employee's Withholding Allowance Form

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Learning & Organization Development

L&OD Web Site

Register for classes by using the Category links on the L&OD home page

L&OD Cancellation Form

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Worker's Compensation Web Site

Report of Work-Related Accident, Injury, or Illness

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