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Forms

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Excellus BlueCross BlueShield Medical Claim Form
BlueCross BlueShield Global Core Claim Form
Excellus BlueCross BlueShield Authorization to Disclose Protected Health Information
Link to online form
OptumRx Mail Order Form
For home delivery of ongoing medications for 90-day refills
Medical/Dental/Vision Enrollment Form
Medical Waiver Form
Change in Status From
Dental Claim Form
Vision Claim Form
For out-of-network services only
Payflex Enrollment Form
PayFlex Claim Form
PayFlex Direct Deposit Authorization Form
PayFlex Claim Filing Instructions
Salary Reduction Agreement
403b Contributions
TIAA-CREF Designation of Beneficiary Form
Fidelity Designation of Beneficiary Form
Application for Tuition Grant for Dependent Children
Application for Horizons Program
Application for Part-Time Study
Course Change Form
Hamilton Honor Code
Tuition Waiver Request (Employee)
Tuition Waiver Request (Spouse/Partner)
Supervisor Approval of Program/Course
Tuition Reimbursement Request
Recruitment Authorization Form
Summer Employment Application
Available 3/6 to 4/3
Background Authorization and Release of Information for Faculty
Background Authorization and Release of Information for Non-faculty
Fair Credit Reporting Act
Article 23-A of NY Correction Law
Employment Authorization
W-4: Federal Employee's Withholding Allowance Certificate
IT-2104: NYS Employee's Withholding Allowance Certificate
All employees must complete this form in order to work in New York State
Direct Deposit Form
I-9: Employment Eligibility Verification Instructions
I-9: Employment Eligibility Verification
Student NY Wage Notice
New York State Wage Notice - Exempt Employees
New York State Wage Notice - Hourly Employees
M&O Leave Bank Donation Form
M&O Leave Bank Withdrawal Form
Staff Leave Bank Donation Form
Staff Leave Bank Withdrawal Form
Performance Assessment (Supervisor)
Performance Assessment (Self)
Supervisor's Accident Investigation Report
Accident Reporting Procedures
Medical Provider Information
Travelers In-Network Suggested Providers
Injured Employee Prescription Fill Form
Information Release

Update Your Contact Information

Address/Personal Information Update

Complete the form to update your record for the HR and the directory.

Review and Edit

Please note: Human Resources will update your address with benefits providers except TIAA. Please contact TIAA directly to update your address. You may update online under "My Profile" or by phone 800-842-2252.

Contact Information

Human Resources

Philip Spencer House
College Hill Road
Clinton, NY 13323
315-859-4302
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