Forms Cabinet

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Benefits Format
- Academic Staff Child Care Benefit ApplicationThis application is filled out annually by academic staff who are eligible to claim reimbursement to a maximum of $2000 per child for incurred child care expenses. More info...PDF
- Accidental Death & DismembermentThis document is a brochure outlining coverage with an application for employees to apply for the Voluntary Accident Insurance Plan. This coverage offers insurance in the event of accidental death or a permanent dismemberment.PDF
- Beneficiary Designation - Great West Life (GWL)This form is used to designate a beneficiary for an employee's life insurance benefit.PDF
- Benefit Orientation Calendar Access FormThis form allows departmental personnel contacts to obtain or cease access to the Human Resources Benefit Orientation Calendar. The calendar is used as a tool to book benefit orientations for new staff to sign up for their pension & benefit coverage.PDF
- Changes to Enrollment of BenefitsThis form is used by an employee to change coverage for a spouse and/or a dependent child for Supplementary Health Care and Dental Benefits. PDF
- Checklist - New Hire with Benefits (Employee)This form can be given to new employees to ensure they prepare the necessary documentation that is required for attendance at the employee's benefits orientation session.PDF
- Common-Law DeclarationThis form is required when an employee wishes to include a common-law partner under their Supplementary Health Care and/or Dental Plan. More info...WORD
- Dental Claim Form - Support Staff
  This form is used by support staff to claim reimbursement for eligible dental expenses covered by the University dental plan. More info...
  PDF
- Dental & Health Spending Account Claim Form - Academic StaffThis form is used by academic staff with a Health Spending Account to submit dental claims as both a University dental plan benefit and a Health Spending Account expense. More info...PDF
- Extended Health Care and Health Spending Account Claim Form - Academic StaffThis form is used by academic staff with a Health Spending Account to submit medical claims as both a Supplementary Health Care plan benefit and a Health Spending Account expense. More info...PDF
- Extended Health Care Claim Form - Support StaffThis form is used by support staff to claim reimbursements for eligible expenses covered by an employee's University Supplementary Health Care plan. More info...PDF
- PSPP - Designation of Beneficiary (PS2)This form is used to designate an employee's beneficiary (or beneficiaries) for the Public Service Pension Plan. More info...PDF
- PSPP - Pension Partner Information (PS5)This form is used to identify a pension partner for the Public Service Pension Plan. A pension partner is automatically the sole beneficiary of pension death benefits. More info...PDF
- Student Attendance DeclarationThis form is used to confirm that a dependant, age 21-25, remains in full time attendance at an accredited educational institution, to continue coverage under the employee's Supplementary Health Care and/or Dental Plan. PDF
- UAPP - Designation of BeneficiaryThis form is used to designate a beneficiary (or beneficiaries) for an employee's Universities Academic Pension Plan. More info...WORD
- Voluntary Critical Illness Application - Academic Staff
  This form is used by academic staff to apply for Voluntary Group Critical Illness coverage above the guaranteed acceptance level for employees and/or spouses. More info...
  PDF
- Voluntary 5-day Personal Leave Plan Application - Academic StaffThis application form is used by an Academic staff member to apply for the Personal Leave Plan (PLP). The PLP is a voluntary plan offering five (5) days of leave without pay with the cost being spread equally over the entire plan period. More info...WORD
- Voluntary 5-day Personal Leave Plan Application - Support Staff
  This application form is used by Support Staff to apply for the Personal Leave Plan (PLP). The PLP is a voluntary plan offering five (5) days of leave without pay with the cost being spread equally over the entire plan period. More info...
  WORD

Funding and Reimbursement Programs Format
- APO Central Professional Development Fund - CPDThis form is used by eligible APOs to apply for funding for travel assistance for professional development and training programs. More info...WORD
- Human Resource Development Fund (HRDF)This form is used by eligible support staff to apply for funding for learning opportunities: courses, workshops, seminars, in-school apprenticeship training or programs. More info...WEBPAGE
- Professional Expense Reimbursement (PER)This program provides eligible academic staff with an annual allocation of funds for the reimbursement of eligible expenses incurred for the performance of their professional responsibilities. More info...WEBPAGE
- Remission of Tuition - Academic StaffThis form allows academic staff to request remission of tuition for U of A credit courses. More info...WORD
- Remission of Tuition - ESL StaffThis form allows ESL support staff to request remission of tuition for U of A credit courses. More info...WORD
- Remission of Tuition - Operating & Trust Support StaffThis form allows Operating or Trust funded support staff to request remission of tuition for U of A credit courses. More info...WORD
- Travel and Expense ReimbursementThis form is used to claim reimbursements for eligible travel related expenses. More info...WEBPAGE

Hiring and Managing Format
- Create New Person IDThis form is used to create a Person ID and/or CCID for a new employee before they begin employment and guests before they arrive.
  EXCEL
- Library Membership for Interim Sessional StaffThis form is used to grant a sessional instructor library privileges including the Academic Client Library Card.
  PDF
- Maternity Leave Approval LetterThis letter is used to provide departmental approval of a written maternity leave without pay request made by a support staff employee. More info...WORD
- Personal Leave Without PayThis letter is used by a department to approve a leave without pay request made by a support staff employee.
  WORD
- Position Information Form (PIF)This form is used to document changes not related to duties or qualifications (e.g. hours of work, speed code, position type or department code) of an employee's position description and have it updated in the employee's file. More info...EXCEL
- Professional Expense Reimbursement (PER) - Trust Academics
  This form is used to allow trust academics to receive reimbursements for eligible expenses within the PER program. More info...
  WORD
- Reasonable Accommodation Fund (RAF) Application FormThis form is used to apply for funding for specific equipment or assistive devices required by an employee due to medical restrictions. More info...PDF
- Reasonable Accommodation Fund (RAF) Medical Documentation FormThis form is used to provide the medical documentation to support a Reasonable Accommodation Fund (RAF) Application Form. More info...
  WORD
- Recurring Term - Commence Inactive PeriodThis form is used to confirm the terms of a recurring term appointment for support staff before they begin an inactive period.WORD
- Recurring Term - Return to Duty from Inactive PeriodThis letter is to be sent to a recurring term support staff employee before they return to duty from an inactive period.WORD
- Recurring Term - Return to WorkThis letter is sent to a recurring term support staff employee before the employee returns to duty from an inactive period.WORD
- Request for Relocation Services (Academic Staff)This form is completed by the hiring unit to help move a new academic staff member and their spouse/partner and dependent children from their current primary residence to their new residence. More info...WORD
- Trust Academic Benefits Stabilization (TABS) Fund Claim for SupportThis form is used by trustholders to apply for financial support from TABS for their eligible Trust/Research academic staff for unforeseen emergency expenses. More info...
  PDF
- TEEF (Trustholder Extraordinary Expenses Fund) Claim for Support This form is used by support staff paid from trust accounts to apply for financial support from TEEF in the form of payment in lieu of notice, general illness or sick leave prior to maternity start and maternity top up. More info...PDF
- Termination of Employment Notice - Hourly Paid Support StaffThis form is completed prior to the original end date on the Casual or Support Appointment/Pay Action form when a Casual Level 1, Casual Level 1 Full-Time Student, Casual Level 2 or Auxiliary Hourly employee ends employment at the U of A, or when a Casual Level 2 or Auxiliary Hourly employee transfers from one department to another. More info...WORD
- Termination of Employment Notice - Support StaffThis form is used when a Regular (continuing or non-established) or Auxiliary Monthly employee ends employment at the U of A or transfers from one department to another.WORD
- Worksheet - Vacation ReconciliationThis form is used for support staff employee vacation reconciliation.EXCEL
- Worksheet - Vacation Reconciliation - Recurring TermThis form is used for recurring term support staff employee vacation reconciliation.EXCEL

Immigration Format
- Application for Labour Market Opinion (LMO)This form is used by an employer to apply for a Labour Market Opinion (LMO) to hire a temporary foreign worker into a high skilled occupation. More info...WEBPAGE
- Foreign Academic Recruitment SummaryThis form is used by a degree-granting educational institution to hire a foreign academic into a position in Canada. More info...WEBPAGE
- Foreign Visitor Category Assessment
  This form is used by an employer to determine the appropriate immigration category, letter of invitation and documents for a foreign visitor. More info...
  PDF

Injury and Illness at Work Format
- Employee's Report of Accident (WCB)
  This form is used by an employee who has sustained a work related injury to report their injury to the WCB. More info...
  PDF
- Employer's Report of Accident (WCB)This form is used by the injured person's supervisor or department/faculty administrator to report a work related injury to Health Promotion & WorkLife Services. More info...PDF
- First Aid ReportingThis form is used to create a first aid report and has detailed instructions on first aid reporting. More info...WEBPAGE
- Functional Abilities/RestrictionsThis form is used to assess the functional abilities of a staff member.WORD
- Out of Province Coverage Application (WCB)This form is used to apply for WCB coverage when travelling outside of the province/country.PDF
- Physical Demands Analysis (WCB)This form is used by WCB to assess how physically demanding a job is. More info...PDF
- Progressive Injury Questionnaire - Employee's (WCB)This form is used by an injured employee to assist the WCB in determining if the progressive injury is work related. More info...PDF
- Progressive Injury Questionnaire - Employer's (WCB)This form is used by an employer to determine whether an employee's progressive injury is work related. More info...PDF

Job Evaluation Format
- Position DescriptionThis template is used to create a written description of an APO, FSO, or SOTS position outlining duties, responsibilities, and qualifications.WORD
- Casual Job DescriptionThis form summarizes the assigned duties and qualifications of a Casual support staff position. More info...WORD
- Job Fact SheetThis template is used to create a written description of a support staff position outlining duties, responsibilites, and qualifications. More info...WORD
- Support Staff Job Evaluation Checklist
  This checklist, in addition to the Job Fact Sheet, will assist Compensation & Job Design in completing the evaluation of support staff positions. More info...
  WORD
- Trust Research/Academic Position DescriptionThis template is used to create a written description of a Trust Research/Academic position outlining duties, responsibilities, and qualifications. More info...WORD

Medical or Illness and Other Leaves Format
- Authorization for Release of Medical InformationThis form is used by the University to collect relevant medical information from an employee under observation for an illness or disability. More info...PDF
- General Illness Leave (Support Staff)This form is used by support staff to provide Proof of Illness when absent from work for a period of more than 3 consecutive work days. More info... PDF
- Maternity Leave Checklist (Employee)This checklist is given to a support staff employee before maternity leave to ensure completion of the necessary steps before and during maternity leave. More info...WORD
- Parental Leave AgreementThis form is completed by an eligible academic staff member prior to taking a parental leave. More info...WORD
- Sabbatical AgreementThis letter is submitted by an academic staff member as a written agreement of the terms and conditions of the employee's sabbatical after a sabbatical request has been approved. More info...WORD
- Sabbatical Application Request
  This form is used by an eligible academic staff member to request a sabbatical. More info...
  WORD
- Sabbatical DirectiveThis form is used by an academic staff member to initiate payroll changes a minimum of one month prior to the start of a sabbatical. More info...WORD

My Employment Format
- Change of AddressThis form is used by an employee to change their correspondence address on file with the University. More info...WORD
- Change of NameThis form is used by a current or former employee to change their name in University records. More info...PDF
- Conflict of Interest - Disclosure Report for Academic StaffThis form is used by academic staff to complete a Conflict of Interest/Commitment disclosure report annually. More info...WEBPAGE
- Conflict of Interest - Disclosure Report for Support StaffThis form is used by support staff with certain responsibilities, or staff who self-identify that they may be in a position of conflict, to report a Conflict of Interest and Conflict of Commitment Disclosure Report annually. More info...WEBPAGE
- Employment Equity Census QuestionnaireThis questionnaire is used by employees to identify that they belong to one or more of the designated groups (persons with disabilities, Aboriginal Peoples, members of visible minorities, women). Participation is voluntary and strictly confidential but not anonymous. More info…WORD
- PREPD Annual Report (APO)
  This form is used by an APO to complete their annual report. More info...
  WORD
- PREPD Annual Report (Temporary Staff)This form is used by a temporary academic staff member to complete their annual report.WORD
- Request for Employment Verification LetterThis form is used by an employee to request a letter that verifies their employment with the Univeristy. More info...WORD
- Request for Employment Verification Letter - Permanent ResidencyThis form is used by an employee to request a letter that verifies employment to apply for permanent residency. More info...WORD

Pay Administration Format
- Academic Education/Prior Work ExperienceThis form is completed for all new employees and is submitted with the Academic Appointment/Pay form or Special Appointment/Pay action form. More info...EXCEL
- Advance RequestThis form is used to request an emergency cheque as an advance on salary. More info...WORD
- Appointment/Pay Action - AcademicThis form is completed when processing any type of pay action for an academic staff member. It is used to inform Payroll Operations of a new appointment, reappointment, extension, transfer, termination, rate change and additional payment. The form is also used for speed code/account changes for salaries and benefits. More info...EXCEL
- Appointment/Pay Action - Adjunct AcademicThis form is completed when processing any type of pay action for an Adjunct Academic staff member. It is used to inform Payroll Operations of a new appointment or reappointment. More info...EXCEL
- Appointment/Pay Action - Augustana Continuing EducationThis form is used by the Augustana Continuing Education department to inform Payroll Operations of a new appointment and changes to a current appointment, such as an extension, rate change and speed code change. More info...EXCEL
- Appointment/Pay Action - Casual SupportThis form is used to inform Payroll Operations of new Casual Support appointment and change to a current Casual Support appointment, such as an extension, rate change, job code change, and additional pay and account change. More info...EXCEL
- Appointment/Pay Action - Clinical AcademicThis form is used to process any type of pay action for a Clinical Academic staff member. It is used to inform Payroll Operations of a new appointment and reappointment. More info...EXCEL
- Appointment/Pay Action - Elder Honorarium FormThis form is used to provide a gift to an aborginal Elder or Knowledge-Sharer.EXCEL
- Appointment/Pay Action - Employment Programs (STEP, CSJ, ISWSP)This form is used to appoint students to the STEP - Summer Temporary Employment Program, CSJ - Canada Summer Jobs and ISWSP - International Student Work Study Program. More info...EXCEL
- Appointment/Pay Action - ESL InstructorThis form is used by the Faculty of Extension to notify Payroll Operations about a new ESL Instructor appointment and the changing of a current ESL Instructor appointment, such as an extension, rate change and speed code change. More info...EXCEL
- Appointment/Pay Action - Excluded StudentsThis form is used to appoint an Undergraduate or Graduate student on the Excluded Student list. This form is used for all new Excluded Student appointments and to indicate changes to a current Excluded Student appointment, such as an extension, rate change, job code change, additional pay, speed code change and a termination of appointment. More info...EXCEL
- Appointment/Pay Action - Faculty of Extension InstructionalThis form is used by the Faculty of Extension to notify Payroll Operations about a new Instructional appointment and to make changes to a current Instructional appointment, such as an extension, rate change and speed code change. More info...EXCEL
- Appointment/Pay Action - Graduate StudentThis form is used to appoint a graduate student performing an assistantship or receiving an awards/scholarship. This form is used to indicate a change to a current Graduate Student appointment such as a rate change, additional pay, change in hours, supplementary appointment, to advise of a termination and to indicate an account change or transfer for employees. More info...EXCEL
- Appointment Pay Action - International Medical TraineeThis form is used by the Faculty of Medicine to process any type of pay action for an international medical trainee. More info...EXCEL
- Appointment/Pay Action - PGME Program FellowsThis form is used by the Faculty of Medicine to process any type of pay action for a PGME Progam Fellow. More info...EXCEL
- Appointment/Pay Action - Special Continuing Academic StaffThis form is used to process any type of pay action for a Special Continuing Academic staff member. It is also used to notify Payroll Operations about a new appointment or reappointment. More info...EXCEL
- Appointment/Pay Action - Special Sessions (inc. Transfer)This form is used to appoint and pay an instructor, lab supervisor, lab assistant, or marking assistant. It is also used to pay a living and travel allowance and coordinate a funding transfer where the individual is a salaried employee and is providing the service as part of their regular salary and benefits and is waiving any additional payment as a result of this appointment. More info...EXCEL
- Appointment/Pay Action - Support StaffThis form is used to appoint support staff or to change a current support staff appointment, such as an extension, transfer, promotion, rate change, change in hours, job code change, and additional pay and speed code change. More info...EXCEL
- Appointment/Pay Action - Undergraduate Student Award/BursaryThis form is used to appoint an undergraduate student receiving a schoorship, bursary and award. More info...EXCEL
- Home Internet Access for Support Staff (Approval & Termination)This form is used to pay an allowance to a support employee for home internet access if required by their employer to access internet from home for work purposes.WORD
- Pay Reporting - Biweekly Time SheetThis form is used to report pay for an employee who is paid hourly biweekly. More info...EXCEL
- Pay Reporting - Call Back & StandbyThis form is used to calculate call back and standby pay.EXCEL
- Pay Reporting - Exception PayThis form is used to calculate exception pay. EXCEL
- Pay Reporting - LeaveThis form is used to calculate leave pay for support staff.EXCEL
- Pay Reporting - Monthly Hourly EmployeesThis form is used for an employee who is paid monthly hourly. More info...EXCEL
- Taxable Benefit FormThis form is used when an employee receives a payment/expenditure that is considered a taxable benefit.WORD
- Visiting Speaker - ExpenseThis form is used to submit expenses incurred by a visiting speaker. More info...EXCEL
- Visiting Speaker - Honorarium Payment (Foreign Currencies)This form is used to give an honorarium payment to a visiting speaker in a foreign currency. More info...EXCEL
- Visiting Speaker - Honorarium Payment (Canadian Funds)This form is used to give an honorarium payment to a visiting speaker in Canadian funds. More info...EXCEL
- Visiting Speaker - Honorarium Payment (US Funds)This form is used to give an honorarium payment to a visiting speaker in US funds. More info...EXCEL

Pay and Tax Information Format
- TD1 (Federal)This form is used by an employer or payer to determine the amount of an employee's tax deductions. More info...WEBPAGE
- TD1 (Federal) - WorksheetThis worksheet is used to calculate partial claims for the amounts on an employee's TD1 (Personal Tax Credits Return) form. More info...WEBPAGE
- TD1AB (Provincial)This form is used by an employer or payer to determine the amount of an employee's provincial tax deductions. More info...WEBPAGE
- TD1AB (Provincial) WorksheetThis worksheet is used to calculate partial claims for the amounts on an employee's TD1AB (Alberta Personal Tax Credits Return) form. More info...WEBPAGE

Recognition Programs Format
- Annual APO, FSO and Librarian Recognition Award Nomination Form (July 1 - April 30)This form is used to nominate an outstanding Administrative Professional Officer (APO), Librarian and Faculty Service Officer (FSO) for the extraordinary contribution made to the University. More info...PDF
- Annual Support Staff Recognition Award (July 1 - Sept 30)This form is used to nominate an outstanding support staff for the extraordinary contribution made to the University. More info...PDF
- Excellence in Leadership Award Nomination Form (March 1 - May 31)This form is used to nominate an outstanding leader or leadership team for the awareness of and attention to issues and concerns that impact the quality of the work and learning environment. More info...WORD
- Excellence in Learning Support Nomination Form (February 1 - April 30)This form is used to nominate a member of the University community whose role does not involve teaching, but who nonetheless directly and significantly contributes to the student learning experience. More info...WORD
- Presidents' Achievement Award Application Form (March 1 - May 31)This form is used to nominate a team for their achievements in support of the University's goals. Presentation of this award will highlight achievements directly related to and in support of the Dare of Discover cornerstones: Talented People; Learning, Discovery and Citizenship; Connecting Communities; and Transformative Organization and Support. More info...WORD

Recruitment Format
- Consent to Collect and Verify InformationThis form is completed by candidates interviewing for a job at the U of A to allows a U of A employee to check their references. More info...WORD
- Reference Check GuideThis guide is used and/or customized to check a candidates references. More info...WORD
- Regret LetterThis letter is a template that can be used to notify an unsuccessful candidate. More info...WORD
- STEP ApplicationThis form is completed by the Faculty/Department to apply for the Summer Temporary Employment Program (STEP) funding. More info...WORD

Retirement Format
- Notice of Retirement and/or Intention to Defer Retirement - Article 18 FAC, FSO, APO & LIB AgreementsThis form is used by academic staff to provide an official written notice of retirement or intention to defer retirement. More info...WORD

Staff Appointment Letters Format
- Academic Staff Appointment Letter - Adjunct AcademicThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - Clinical AcademicThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - Contract Academic Staff: TeachingThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - FacultyThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - Sessional and Other Temporary StaffThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - Term Excluded ContractThis letter is used to confirm terms of employment. More info...WORD
- Academic Staff Appointment Letter - Trust/Research AcademicsThis letter is used to confirm terms of employment. More info...WORD
- Student Staff Appointment Letter - Casual Full-Time StudentThis letter is used to confirm terms of employment. More info...WORD
- Student Staff Appointment Letter - Excluded U of A StudentThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Auxiliary HourlyThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Auxiliary MonthlyThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Auxiliary Monthly Post RetirementThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Casual Level 1This letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Casual Level 2
  This letter is used to confirm terms of employment. More info...
  WORD
- Support Staff Appointment Letter - RegularThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Regular RecurringThis letter is used to confirm terms of employment. More info...WORD
- Support Staff Appointment Letter - Temporary Transfer/Promotion (Secondment)This letter is used to confirm terms of employment. More info...WORD

Human Resource Services

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Forms Cabinet

Benefits Format

Funding and Reimbursement Programs Format

Hiring and Managing Format

Immigration Format

Injury and Illness at Work Format

Job Evaluation Format

Medical or Illness and Other Leaves Format

My Employment Format

Pay Administration Format

Pay and Tax Information Format

Recognition Programs Format

Recruitment Format

Retirement Format

Staff Appointment Letters Format