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Forms

Excellus BlueCross BlueShield Medical Claim Form
BlueCross BlueShield Global Core Claim Form
Excellus BlueCross BlueShield Authorization to Disclose Protected Health Information
Can be completed online
OptumRx Mail Order Form
For home delivery of ongoing medications for 90-day refills
Dental Claim Form
Vision Claim Form
For out-of-network services only
Medical/Dental/Vision Enrollment Form
Medical Waiver Form
PayFlex Claim Form
Payflex Enrollment 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
Hamilton Honor Code
Course Change Form
Tuition Waiver Request (Employee)
Tuition Waiver Request (Spouse/Partner)
Supervisor Approval of Program/Course
Tuition Reimbursement Request
Recruitment Authorization Form
Background Authorization and Release of Information for Faculty
Background Authorization and Release of Information for Non-faculty
Fair Credit Reporting Act
Summer Employment Application
Available 3/6 to 4/3
Article 23-A of NY Correction Law
Employment Authorization
2018 W-4: Federal Employee's Withholding Allowance Certificate
2018 IT-2104: NYS Employee's Withholding Allowance Certificate
All employees must complete this form in order to work in New York State
I-9: Employment Eligibility Verification
I-9: Employment Eligibility Verification Instructions
Direct Deposit Form
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
Information Release
Medical Provider Information
Travelers In-Network Suggested Providers
Injured Employee Prescription Fill Form

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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