Forms

Employment Forms

You will need Acrobat Reader to download and print these forms.

IPFW Employment Forms

• **NEW** Background Check Information/Consent Form
• **NEW** Motor Vehicle Report (MVR) Consent Form
• Recruitment Request Form (Form HREO-1)
• Request to Interview (Exempt/Salaried) (EEOR-2)
• Request to Interview (Non-Exempt/Hourly) (EEORN-2)
• Request to Extend Offer (Exempt/Salaried) (EEOR-3)
• Request to Extend Offer (Non-Exempt/Hourly) (EEORN-3)
• Recruitment Checklist for Non-Faculty Positions
• Request for Exception to Nonexempt Pay Scales [Word]

Position Request Forms (MS Word files)

• Clerical/Service/Administrative/Professional Position Description & Position Request Form
• Temporary Position Description & Request Form [Word]
• Faculty Position Request
• Continuing Lecturer Position Request
• Fellowship Position Request
• Grouped Position Request

Payroll Forms

You will need Acrobat Reader to download and print these forms.

• Request for Duplicate W2
• HR Signature Authorization Form
• Personnel Action Form
• Additional Pay Form (overloads, awards)
• Faculty contract (Form 19)
• Limited-Term/Continuing Lecturer contract (Form 19L)
• Employee Information Form (Form 13FW) [PDF]
• Self Identification Compliance Form [PDF]
• Leave request - general (Form 33Absence)
• Leave Action Form (VEPR, military, personal, and FMLA leaves, and for nonworking months when FY appointment is less than 12 months)
• Request and Leave Action Form (Sabbatical and research leaves; replaces both Form 33F and Leave Action form for these leaves)
• Employment Eligibility Verification (Form I-9) (now done on-line)
• Direct deposit application [PDF]
• Electronic Pay Card application [PDF] 
• Federal W-4 [PDF]
• State WH-4
• Form 57 (overload/extra duty) [PDF]

Benefits Forms

You will need Acrobat Reader to download and print these forms.

Medical Forms

• Tobacco User Certification Form (PDF)
• CIGNA Medical Clam Form
• MEDCO Mail Order Form (Co-pay and Incentive Plan)
• MEDCO Rx Claim Form (Co-pay and Incentive Plan)

Flexible Spending Account (FSA) Forms

• Claim Form for both Medical and Dependent Care 

Health Savings Account (HSA) Forms

•  CIGNA HSA deposit slip

Retirement Forms

• Request of Estimate of Benefits
• Application for Waiver of Three-Year Waiting Period 403(b) Defined Contribution Base Retirement Plan Form

Fee Remission Information

• Apply for IU Fee Courtesy
• IPFW Fee Remission [PDF]/ Credit Hour Exception Request [PDF]
• Purdue University Executive Memorandum No. C-7
• Purdue (W.L. campus) Fee Remission [PDF]