Forms/Documents:Human Resources:SUNY Upstate Medical University

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Title	Description	Category
'Patients First' Philosophy text	Patients First poster	Training and Development
'People First' Philosophy text	People First flyer	Training and Development
'Students First' Philosophy text	'Students First' Philosophy	Training and Development
2009 Employee Handbook Research Foundation Benefits Introduction text	Intro to the RF benefits handbook	Health Insurance, Dental and Vision
2009 Research Foundation Benefits Information text	Information on benefits for RF employees	Benefits (General)
Allergy Screening Formⁱ text	Used to record allergy history of new staff and students at Upstate.	Hiring and Recruitment
Applicant Information - SUNY Upstate Medical University text	General information on applying for a job at SUNY Upstate.	Hiring and Recruitment
Benefit Fund Enrollment Form, CSEA Employeesⁱ text	CSEA employees use this form to enroll in benefits	Benefits (General)
Benefits FAQ - Research Foundation text	Benefits FAQ - Research Foundation	Benefits (General)
Benefits FAQ - State Employees text	Benefits FAQ - State Employees	Benefits (General)
Benefits Pamphlet - CSEA text	Benefits Pamphlet - CSEA	Benefits (General)
Benefits Pamphlet - PEF text	Benefits Pamphlet - PEF	Benefits (General)
Benefits Pamphlet - UUP text	Benefits Pamphlet - UUP	Benefits (General)
Benefits Summary - Management Confidential text	Benefits summary for new Management Confidential employees.	Benefits (General)
Benefits Summary - PEF text	Summary of benefits for new employees represented by PEF.	Benefits (General)
Benefits Summary - Research Foundation text	Summary of benefits for new Research Foundation employees.	Benefits (General)
Benefits Summary - UUP text	Benefits summary for new employees represented by UUP.	Benefits (General)
Benefits Summary Booklet - Management Confidential (M/C text	Benefits Summary Booklet - Management Confidential (M/C	Benefits (General)
Benefits Summary, CSEA Employees text	Summary of benefits for new CSEA represented staff.	Benefits (General)
Benefits Summary, Council 82/NYSCOPBA Employees text	Benefits at a Glance Police and Security Employees	Benefits (General)
CHOP - Job Titles of Employees Required to Attend text	CHOP is an orientation class required for all clinical staff.	Training and Development
CITI IRB Course Instructions text	The CITI IRB course is to be completed by all clinical staff within 12-months of hire date unless notified by the IRB Office as a name listed on the IRB Protocol.	Training and Development
CPR Presentation - American Heart Association text	This presentation should be viewed before attending CPR class.	Training and Development
CSEA Benefits - Important Contact Numbers text	List of Benefits contacts for CSEA represented staff.	Benefits (General)
CSEA Benefits At a Glance text	Summary of benefits for CSEA employees.	Benefits (General)
Campus Map - Jacobsen Hall and parking text	Campus map for new hires	Hiring and Recruitment
Candidate Selection Justification - Office of Diversity and Affirmative Action	Candidate Selection Justification - Office of Diversity and Affirmative Action	Hiring and Recruitment
Certificate of Health Statement text	The certificate of health is for anyone coming to Upstate for 30-days or more.	Miscellaneous
Certificate of Health Statement instructions text	This document accompanies the Certificate of Health Statement for visitors to Upstate for 30 days or more.	Miscellaneous
Check Diversion Request Formⁱ text	Used by employees to change or specify options for the distribution of their paycheck.	Payroll
Child Care Center Enrollment Application text	For enrolling your child into Upstate Child Care Center	Benefits (General)
Clinical Practice Orientation (CPO) Agenda text	For clinical staff and takes place in the afternoon after Day 2 of New Employee Orientation.	Training and Development
Confidentiality Agreement text	New staff and individuals participating in Job Shadowing or Intership programs at SUNY Upstate must fill out this form	Training and Development
Dental Claim Form - Delta - UUP	Effective 04/01/2008 UUP employees can use this form to make a dental claim.	Health Insurance, Dental and Vision
Detailed Health Statement text	Individuals participating in Job Shadowing or Intership programs at SUNY Upstate must fill out this form (will be at Upstate for greater than 3 days)	Training and Development
Employee Information Sheetⁱ text	Used to collect personnel data of new employees at Upstate.	Hiring and Recruitment
Employment Eligibility Verification Form (I-9)ⁱ	Used to verify an employees eligibility to work in the United States	Hiring and Recruitment
Federal Tax Form/W-4ⁱ text	Federal tax withholding form	Payroll
Guide to Using the Human Resources Website text	Helps familiarize you with how to find what you need on the HR website.	Miscellaneous
HIPAA Privacy Rule Education Certificate text	Form to record completion of HIPAA privacy education	Training and Development
Health Insurance - Proof of Eligibility text	Explains proof of eligibility an employee can provide in order to in enroll NYSHIP	Health Insurance, Dental and Vision
Health Insurance Ineligibility Formⁱ text	Employees who are ineligible for New York State health insurance are required to sign this form.	Health Insurance, Dental and Vision
Health Insurance Pre-Tax Contribution Programⁱ text	Information on pre-tax health insurance premium contributions	Health Insurance, Dental and Vision
Health Insurance Transaction Form - PS404ⁱ text	Used by State employees to enroll in or change status with a health insurance plan	Health Insurance, Dental and Vision
Hiring System Tutorial - Changing Applicant Status text	For hiring managers using the online hiring system	Hiring and Recruitment
Holiday Calendar text	Upstate Holiday Calendar	Payroll
Hring System Document Types text	Intended for hiring managers using the Online Hiring System	Hiring and Recruitment
Internal Transfer Request (Online Tutorial) text	*For current Upstate staff ONLY. How to submit an internal transfer request online via the hiring system.	Hiring and Recruitment
Management Confidential (M/C) Benefits At a Glance text	Summary of benefits for M/C employees	Benefits (General)
Management Confidential Benefits - Important Contact Numbers text	Management Confidential Benefits - Important Contact Numbers	Benefits (General)
Map of Jacobsen Hall, parking, and Medical Staffing Office text	Map for new hires.	Hiring and Recruitment
Medical History - Student/Employee Healthⁱ text	Used to record medical history of new staff and students at Upstate.	Hiring and Recruitment
NYS 2009 Bi-Weekly Health Insurance Rates for CSEA, PEF, and UUP Represented employees and M/C employees text	Lists the 2009 bi-weekly employee cost for the various health insurance plans while in a paid or leave without paid status...Category Health Insurance, Dental, and Vision.	Health Insurance, Dental and Vision
NYS Balance - Work Life Balance Program text	NYS Balance is designed to help NYS employees and their families save time, and help you better balance work and life. This program offers fast, confidential services 24 hours a day, seven days a week, and provides information on a wide variety of issues & subject matters.	Benefits (General)
NYS Employees’ Retirement System Article 15 Membership formⁱ text	Used to enroll in the Employees’ Retirement System when joining the retirement system	Retirement
NYS Health Insurance Plan Description - Choices 2009 text	Choose your Health Insurance Plan and Pre-Tax Status for 2009	Health Insurance, Dental and Vision
NYS Retiree Health Insurance FAQs text	The information provided will assist NYS employees who are planning on retiring in the near future to better understand their health insurance benefits as a retiree	Retirement
NYS Worksite Child Care Centers text	A network of child care centers supported by NYS and the public employee unions.	Benefits (General)
New Employee Orientation - Checklist of Items Needed for Your First Day text	Checklist of items that new staff will need to bring on Day 1 of New Employee Orientation.	Hiring and Recruitment
New Employee Orientation - Directions to Parking Garage, map of Upstate text	Map for new employees on where to park on their first day of orientation.	Hiring and Recruitment
New Employee Orientation Agenda - Day 1 text	Agenda of topics for Upstate New Employee Orientation.	Hiring and Recruitment
New Employee Orientation Agenda - Day 2 text	Agenda of topics for Upstate New Employee Orientation.	Hiring and Recruitment
New Employee Orientation Handbook text	General information for new Upstate staff.	Hiring and Recruitment
New Employee Orientation Schedule text	List of dates of all orientation classes offered through Organizational Training and Development.	Hiring and Recruitment
New York State Employees Retirement System (ERS)-Overview Information text	New York State Employees Retirement System (ERS)-Overview Information	Retirement
Non-Discrimination Policy text	Upstate’s policy of non-discrimination based on age, race, creed, religion, color, national origin, sexual orientation, military status, sex, disability, or marital status of any person.	Employee/Labor Issues
Non-Employee Confidentiality Handbook text	This handbook should be read by all agency employees, students, and volunteers.	Training and Development
Non-Employee ID Request Form text	In order for a Non-Employee to have access to various SUNY Upstate Medical University information systems, this form must be completed and submitted to Payroll Services Department	Training and Development
Nursing Services Orientation (NSO) - Class Description text	describes course content of NSO for new nursing staff.	Training and Development
Nursing Services Orientation (NSO) Agenda text	Nursing Services Orientation (NSO) is for Nursing and Nursing Support staff.	Training and Development
ORP Overview (SUNY Optional Retirement Program) text	Summary on SUNY Optional Retirement Program	Retirement
Oath of Office Formⁱ text	Certifies that a State employee has read and understands the NYS Public Officer’s Law	Payroll
Oath of Office Form - Native Americanⁱ text	Certifies that a State employee has read and understands the NYS Public Officer’s Law (Alternative form for use by Native Americans)	Payroll
PEF Benefits - Important Contact Numbers text	PEF Benefits - Important Contact Numbers	Benefits (General)
PEF Benefits At a Glance text	Benefits summary for PEF employees	Benefits (General)
Photo Consent Form text	used by visitors to authorize use of images	Miscellaneous
President's Summer Internship / Mentoring Program text	The President's Summer Internship / Mentoring Program is a strategic initiative sponsored by the Presidents Office and the Office of Diversity and Affirmative Action in collaboration with the urban community.	Miscellaneous
Professional Reference Check Form	Professional Reference Check Form	Hiring and Recruitment
Research Foundation 2009 Benefits Outline text	Provides a brief overview of benefits offered to regular employees and is intended mainly for prospective employees	Benefits (General)
Research Foundation 2009 Bi-Weekly Health Insurance Rates...Description text	Lists the 2009 bi-weekly employee cost for the various health insurance plans while in a paid or leave without paid status	Health Insurance, Dental and Vision
Research Foundation 2010 Flexible Spending Account Online Enrollment Guide text	Research Foundation 2010 Flexible Spending Account Online Enrollment Guide	Health Insurance, Dental and Vision
Research Foundation Benefits - At a Glance text	Summary of RF benefits	Benefits (General)
Research Foundation Benefits - Important Contact Numbers text	Research Foundation Benefits - Important Contact Numbers	Benefits (General)
Research Foundation Benefits Enrollment Formⁱ text	Used by Research Foundation employees to enroll in or make changes to benefits	Health Insurance, Dental and Vision
Research Foundation Benefits Frequently Asked Questions text	Information on Benefits for new Upstate staff.	Benefits (General)
Research Foundation Benefits Reference Guide text	Provides a brief summary of benefits offered to regular, benefits-eligible employees	Benefits (General)
Research Foundation Benefits: Medco Prescription Drug Benefit text	Research Foundation Benefits: Medco Prescription Drug Benefit	Benefits (General)
Research Foundation Employee Handbook text	Information for those employed by the Research Foundation	Hiring and Recruitment
Research Foundation HMO Enrollment Form text	Used by Research Foundation employees to enroll in or make changes to their HMO.	Health Insurance, Dental and Vision
Research Foundation Injury Report Form ⁱ text	Research Foundation employees should use this form to report an injury sustained on the job.	Worker's Compensation
Research Foundation Life Insurance Enrollment Form text	Used by Research Foundation employees to enroll in Prudential optional Term Life Insurance	Benefits (General)
Research Foundation MVP Enrollment Formⁱ text	Used by Research Foundation employees to enroll in or make changes to their MVP health plan	Health Insurance, Dental and Vision
Research Foundation Retiree Benefits FAQ text	The information provided will assist RF employees who are planning on retiring in the near future to better understand their health insurance benefits as a retiree.	Retirement
Research Foundation Short Term Disability Form text	Used by Research Foundation employees to enroll in First Reliance Standard Voluntary Short Term Disability Income Protection	Benefits (General)
Research Foundation-Retirement Plan Overview text	Research Foundation-Retirement Plan Overview	Retirement
Resident Orientation Agenda text	schedule of activities conducted at new resident orientation (OTD & GME office)	Training and Development
Retirement Program Election Form ⁱ text	Used by UUP and Management Confidential employees to specify their choice of retirement program	Retirement
Retirement Program History Sheetⁱ text	Used by new employees to communicate prior participation in a retirement system.	Retirement
Retirement: New York State Public Employee and Retireee Long Term Insurance Care Plan formⁱ text	Information on the NYSPERL program	Benefits (General)
Retirement: TIAA-CREF Discipline Investment Management	The purpose of this guide is to provide an overview of TIAA-CREF's investment options.	Retirement
Retirement:TIAA-CREF Investment Guide text	Booklet describing TIAA-CREF retirement fund investment options.	Retirement
Risk Release Form text	Individuals participating in Job Shadowing or Intership programs at SUNY Upstate must fill out this form	Training and Development
SUNY "Perks" Employee Discount Program Flyer text	Informational flyer on this state employee discount program	Benefits (General)
SUNY Optional Retirement Progam Form (UUP or M/C)ⁱ text	Used by UUP and Management Confidential employees to specify their choice of state retirement program	Retirement
SUNY Optional Retirement Program: Enhance Benefits text	Illustrates changes in employee and employer contribution rates to the SUNY Optional Retirement Program (ORP), specifically as related to tier 3,4, and 4A members	Retirement
SUNY Upstate Medical University On-Line Employment System Frequently Asked Questions text	FAQ for online applicants	Hiring and Recruitment
Security Information Form ⁱ text	Used to collect security data for new employees at Upstate.	Hiring and Recruitment
Short Term Health Statement text	Individuals participating in Job Shadowing or Intership programs at SUNY Upstate must fill out this form (will be at Upstate for less than 3 days)	Training and Development
Smoke Free Upstate and Surrounding Area text	Q & A about this ordinance, effective November 1, 2009.	Miscellaneous
State Benefits Frequently Asked Questions text	Information on Benefits for new Upstate staff.	Benefits (General)
State Direct Deposit Formⁱ text	Used to request that bi-weekly paychecks be deposited into the account or accounts of choice	Payroll
State Employee Leave of Absence Request Form (for Personal Leave and "Title F" Leave only) text	State employees can use this form to request a leave of absence - can be used for both FMLA and Non-FMLA leaves.	Leave of Absence/Disability Leave (including FMLA Leave)
State Employees - Benefits Option Transfer Planning for 2010 text	Advisement booklet on changing health insurance options.	Health Insurance, Dental and Vision
State Injury Report Formⁱ text	State employees should use this form to report an injury sustained on the job.	Worker's Compensation
State Long Term Disability Form text	Used by UUP and Management Confidential employees to establish elegibility for SUNY’s Group Long Term Disability Insurance Program	Benefits (General)
State Tax Form/IT-2104ⁱ text	State tax withholding form	Payroll
State Tax Form/IT-2104-Eⁱ text	Used to claim exemption from New York State tax	Payroll
State/Research Foundation Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave text	State/Research Foundation Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - can be used for both FMLA and Non-FMLA leaves.	Leave of Absence/Disability Leave (including FMLA Leave)
State/Research Foundation Certification of Qualifying Exigency For Military Family Leave text	State/Research FMLA State Certification of Qualifying Exigency For Military Family Leave - can be used for both FMLA and Non-FMLA leaves.	Leave of Absence/Disability Leave (including FMLA Leave)
State/Research Foundation Employee Certification of Health Care Provider for Employee's Serious Health Condition text	State/Research Foundation Employee Certification of Health Care Provider for Employee's Serious Health Condition - can be used for both FMLA and Non-FMLA leaves.	Leave of Absence/Disability Leave (including FMLA Leave)
State/Research Foundation Employee Certification of Health Care Provider for Family Member's Serious Health Condition text	State/Research employees can use this form to request a leave due to serious illness of a family member - can be used for both FMLA and Non-FMLA leaves.	Leave of Absence/Disability Leave (including FMLA Leave)
Survivor’s Benefit Programⁱ text	This form is used if part time and declining to enroll in NYS Employees’ Retirement System	Retirement
TIAA-CREF Retirement Enrollment Formⁱ text	Used to collect information on UUP employees enrolling in TIAA-CREF retirement program	Retirement
Trauma Kids Program - Short Term Health Statement text	Trauma Kids Program - Short Term Health Statement	Miscellaneous
Trauma Kids Program Agenda text	Trauma Kids Program Agenda	Miscellaneous
Trauma Kids Program Registration Form text	Trauma Kids Program Registration Form	Miscellaneous
Tuition Assistance Form (B-140R) text	Apply for employee tuition assistance for classes taken at institutions other than SUNY	Benefits (General)
Tuition Assistance Form - Part II text	Supplement to B140R and B140W tuition assistance form	Benefits (General)
Tuition Waiver Form (B-140W) text	Apply for employee tuition assistance for classes taken at any SUNY campus	Benefits (General)
UUP Benefit Trust Fund Enrollment Cardⁱ text	For UUP employees to enroll in UUP Benefit Trust Fund that provides coverage for dental, vision and tuition scholarship	Hiring and Recruitment
UUP Benefits At a Glance text	Benefits summary for UUP employees	Benefits (General)
UUP Group Life Insurance Beneficiary Card Application text	Used by UUP employees to apply for UUP Group Life Insurance	Benefits (General)
UUP Laser Vision Correction Direct Reimbursement Claim Form	UUP employees can use this form to request reimbursement for Laser Vision Correction services received.	Health Insurance, Dental and Vision
UUP Tuition Waiver text	This program waives full tuition expenses for credit coursework taken on either a credit or audit basis at 4-year SUNY institutions.	Benefits (General)
Upstate Mission, Vision, and Values text	Upstate Mission, Vision, and Values	Miscellaneous
Upstate Pledge text	The Upstate Pledge is our organization's code of conduct and mutual respect.	Hiring and Recruitment
Veteran Status Formⁱ text	Used by employees to declare veteran status	Payroll
Worker's Compensation Claimant Information text	Information about making a worker's compensation claim.	Worker's Compensation