Forms
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Benefits-Related
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Benefits Enrollment: Benelogic System Login
Log in to Benelogic to enroll in health, dental, long-term disability, life, flexible spending, or supplemental insurance. Contact HR at 518-276-6302 for login information.
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Retirement Enrollment
Enroll in retiree health or dental plans (if eligible).
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Met Life Dental Claim
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Retirement Program Enrollment
Used to enroll in the Defined Contribution Retirement Program.
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Supplemental
Retirement Program Enrollment
Salary Reduction Agreement (SRA).
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Tuition Scholarship Request
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Professional Development Registration
Used to register for development and training courses.
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Dependent Care Flexible Spending
Reimbursement
Reimbursement for any dependent care expenses.
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Medical Flexible Spending Plan Reimbursement
Reimbursement for any medical expenses.
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Dependent
Care Provider's Identification and Certification
(W-10)
This form must be submitted to the Flexible Spending Plan Administrator.
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Dependent Care Certification
This form is required for all dependent care reimbursements.
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Life Insurance Beneficiary Designation: Benelogic
Login
Log-in to ensure that your Beneficiary Designation is up-to-date on the Benelogic System.
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Limit Life Insurance
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Name / Address Change
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Non-Exempt
Short Term Disability
Completion of this form is required for absences in excess of five (5) business days.
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Occupational / Illness Injury Form
Report any occupational injury or illness immediately to your supervisor!
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Benefits Enrollment: Benelogic System Login
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Employment-Related
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Employment Transaction
Used to start new employment, change existing employment, or end employment.
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Position Approval
Used by academic departments to request new faculty positions.
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Recruitment Plan
Tracking tool for employee recruitment action items and activities.
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Candidate Personal Interview Evaluation
Used to document candidate interviews.
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NEW!
Employment Eligibility
Verification (I-9)
Used to comply with the Immigration Reform and Control Act of 1986 (IRCA).
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Telephone
Reference Check
Three must be completed and signed for each candidate before a candidate can be hired.
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Affirmative Action Approval Form (Faculty)
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Affirmative Action Approval Form (PostDoc)
Please note that staff hiring proposals are now submitted on-line using the " People Admin" system.
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On-line Performance
Evaluation Tool (Formerly the "PMT")
Please contact the Division of Human Resources at 518-276-2774 to discuss the Performance Management Process.
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Position Reclassification Form
Please contact the Division of Human Resources at 518-276-2774 to discuss the reclassification process.
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2009
Federal Tax Withholding (W-4)
This form must be submitted to Rensselaer's Payroll Office.
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2009 New York State Tax Withholding (IT-2104)
This form must be submitted to Rensselaer's Payroll Office.
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2009 New York State Certificate of Exemption from
Withholding (IT-2104-E)
This form must be submitted to Rensselaer's Payroll Office.
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2009 State of Connecticut Employee Withholding
Certificate(CT-W4)
This form must be submitted to Rensselaer's Payroll Office.
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Exempt Staff Supplemental Pay Authorization
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Employment Separation Checklist
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Appeal of Disciplinary Action
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Employment Transaction