The Office of Human Resources

UVA Health Plans

• Authorization to Disclose Protected Health Information
• Authorization to Disclose Protected Health Information to Family Member or Other Person
• Foreign Country Enrollment Form
• Health/Dental/Vision Application

Virginia Retirement System Forms (VRS)

• Election to Participate
• VRS Hybrid Forms Website

Life and AD&D Insurance

• Standard Life Beneficiary Form
• VRS - Minnesota Life Optional Life Enrollment Form
• VRS - Minnesota Life Optional Life Change Form
• VRS - Minnesota Life Beneficiary Change Form
• VRS - Minnesota Life Evidence of Insurability
• VRS - Minnesota Life Conversion Form
• Standard Waiver of Premium Claim Form

ORP, MCRP, TDSP and Cash Match

• Fidelity Enrollment, Fund and Performance Information
• Fidelity 401a Beneficiary form
• Fidelity 401a/403b Combination Beneficiary Form
• TIAA-CREF Enrollment, Fund and Performance Information

Education Benefits

• UPG Continuing Education Policy

Forms

• Sign-On Bonus Agreement Form and Policy
• Request for Exception to Policy 401 - Medical Center (will download automatically when clicked on)

Policies

• Academic Division
  • HRM 024: Compensation Program for University Staff Employees
  • HRM 035: University Faculty Salaries and Bonuses
  • HRM 046: Overtime Management for Non-Exempt Employees
• Medical Center
  • HR 401: Pay Administration
  • HR 402: Compliance with The Fair Labor Standards Act

Forms

• Attendance Policy Addendum Template - Medical Center
• Knowledge Transfer Template
• Name & Address Change Form - Medical Center - No longer in use. Please make changes through Workday:
  • View Profile under your name
  • Click on "Personal" category
  • Select "Names" tab
• Offboarding Checklist
• Removal of Access Privileges and Return of UVA MC Property

Policies

• HR 109: Personnel Records - Medical Center
• HRM 002: Issuance and Use of University Identification Cards
• HRM 044: Maintaining Faculty Personnel Records

Forms

• Medical Center
  • Employee Fitness for Duty Observation Report
  • Internal Alignment Form
  • Request for New or Changed Position

Policies

• Academic Division
  • HRM 009: Preventing and Addressing Discrimination and Harassment
  • HRM 010: Preventing and Addressing Retaliation
  • HRM 014: Standards of Conduct for University Staff Employees
  • HRM 027: Resolving Grievances for University Staff Employees
  • HRM 028: Preventing and Addressing Threats or Acts of Violence
  • HRM 031: Employees Ineligible for Rehire
  • HRM 040: Reporting by University Employees of Disclosures Relating to Sexual and Gender-Based Harassment and Other Forms of Interpersonal Violence (the Title IX Policy)
  • HRM 041: Policy on Sexual and Gender-Based Harassment and Other Forms of Interpersonal Violence
  • HRM 043: Addressing Grievances for Administration and Professional Non-Tenure-Track Faculty
  • HRM 050: Protection of Minors and Reporting Abuse
• Medical Center
  • HR 701: Employee Standards of Performance and Conduct

Forms & Resources

• Flexwork Agreement Form
• Request for Exception from Policy 401 - Medical Center
• Safety Checklist for Remote Work
• Technology Use Agreement Form
• Travel Time Guidelines for Non-Exempt Staff
• University Staff Election form
• UVA Health Telework Agreement Form
• UVA Health Telework Guidelines and FAQs
• UVA Health Telework Technology Guide
• UVA Telecommuting Assessment Tool

Policies

• General
  • PRM 011: Use of Working Time and University Equipment for Personal or Commercial Purposes
• Academic Division
  • HRM 003: Employment of Administrative or Professional General Faculty Members
  • HRM 011: Campaigning for and Serving in Public Office
  • HRM 012: Workplace Flexibility
  • HRM 017: Temporary Reduction in Workforce for University Staff Employees
  • HRM 019: University Staff Employees, Medical Center Team Members, and Classified Staff Engaged in Teaching
  • HRM 025: Professional Service and External Consulting for University Staff Employees
  • HRM 029: Managing Wage Staff Employment
  • HRM 031: Employees Ineligible for Rehire
  • HRM 032: Disruption of Normal Unversity Operations Resulting from Weather or Emergency Events
  • HRM 033: Employment of Professional Research Staff
  • HRM 045: Faculty External Consulting and Internal Overload
• Medical Center
  • HR 201: Employment Categories
  • HR 301: Educational Assistance (replaced with Medical Center Education Benefits Program document)
  • HR 502: Work Hours and Schedules
  • HR 510: Modified Medical Center Operations
  • HR 701: Employee Standards of Performance and Conduct
  • HR 702: Fitness for Duty
  • HR 704: Attendance
  • HR 706: Supervision of Relatives
  • HR 707: Violations of Confidentiality
  • HR 901: Employee Referral Incentive Program
  • HR 905: Health Care Provider Licensure/Certification Policy
  • HR 910: Campaigning for and Serving in Public Office
• Health System
  • Telework Health System Policy

Forms

• FICA Release Letter
• Payroll Adjustment Form - Medical Center
• Time Management Form
• Time Management Form Shift Work

Policies

• HRM 007: Direct Deposit of Payroll Payments
• HRM 008: Student FICA Tax Exemption

• H-1B Packet
• TN Packet USA
• TN Visa Packet (Port of Entry processing only)

Forms

• Academic Staff Bone Marrow or Organ Donation Certification
• Academic Staff Overtime Leave Cash Out Request
• Academic Recognition Leave Request
• Academic Leave Sharing Request
• Academic Leave Sharing Donation

• Medical Center Personal and Educational Leave Request Form
• Medical Center PTO Donation Form
• Medical Center PTO Donation Request Form

• UPG Paid Parental Leave Form

Policies

• Academic Division
  • HRM 013.01: Paid Leave for University Staff Employees
  • HRM 036: Use of Disaster Leave
  • HRM 038: Faculty Leave 
  • HRM-013: Available Leave Types for University Staff Employees
  • HRM-013.02: Paid Parental Leave for University Staff
  • HRM 026: Family, Medical, and Military Leave
  • DHRM polices for Classified Staff
  • HRM-013.04: Bereavement Leave for University Staff Employees

• Medical Center
  • Paid Time Off
  • Leaves of Absence

• University Physicians Group
  • UVA Physicians Group Civil Leave Policy
  • UVA Physicians Group FMLA Policy
  • UVA Physicians Group Holidays and Holiday Compensation
  • UVA Physicians Groups Leave of Absence Policy
  • UVA Physicians Group Paid Parental Leave Policy
  • UVA Physicians Group PolicyTech - Browse

Forms

• Exceptional Performance Form
• Fitness for Duty Initial Observation Report - Medical Center
• Informal Counseling Form - Attendance - Medical Center
• Informal Counseling Form - Tardies - Medical Center
• Informal Counseling Form - Job Performance - Medical Center
• Informal Counseling Memo - Violations of Confidentiality - Medical Center
• Internal Alignment Form - Medical Center
• New Changed Position - Medical Center
• Notice of Improvement Needed
• Performance Counseling How To Guide - Medical Center
• Performance Improvement Counseling (PIC) - Medical Center
• Probationary Extension Form - Medical Center
• Probationary Progress Review/Extension/Completion Form
• Team Member Performance Improvement Plan Guideline - Medical Center
• Team Member Performance Improvement Plan (TPIP) - Medical Center

Policies

• Academic Division
  • DHRM Policy 1.15 Employee Recognition and Engagement
  • HRM 018: Performance Management for University Staff Employees
  • HRM 023: Career Development for University Staff Employees
  • HRM 037: Evaluating Employee Fitness for Duty
• Medical Center
  • HR 116: Promotions, Demotions, and Transfers
  • HR 205: Probationary Period 
  • HR 209: Performance Management Program
  • HR 210: Competency Assessment
  • HR 301: Educational Assistance - replaced with Medical Center Education Assistance Program document
  • HR 701: Employee Standards of Performance and Conduct
  • HR 702: Fitness for Duty 
  • HR 704: Attendance
  • HR 806: Employee Rewards and Recognition Programs

Resources

• Behavioral Interviewing Guide
• EOCR Search Committee Training
• Hiring and Recruiting Individuals with Disabilities

Forms

• Dual Employment Request
• Move Agreement Form
• Moving & Relocation Expense Summary - Medical Center
• Position Description Degree Requirement Analysis Worksheet
• Remote Hire Notice Form
• Removal of Access Privileges and Return of UVA MC Property
• Reassignment Request Form
• Onboarding and Offboarding

Policies

• General
  • EOCR Posting and Training Requirements
• Academic Division
  • HRM 001: Authorization of Volunteers in the Workplace
  • HRM 004: Faculty Resignation and Retirement Notice
  • HRM 005: Appointment of Unpaid Faculty
  • HRM 015: Layoff for University Staff Employees
  • HRM 016: Severance Benefits for University Staff Employees
  • HRM 020: Probationary Period for University Staff Employees
  • HRM 021: Terms and Conditions of University Staff Employment
  • HRM 022: Employment Eligibility Verification (Completing Form I-9)
  • HRM 030: Recruiting and Hiring of University Staff and Wage Employees
  • HRM 034: Background Checks, Screening, and Ongoing Responsibility for Employees to Disclose Criminal Convictions
    • HRM-034 Background Check Procedures
  • HRM 039: Approval of Appointments and Reappointments of Senior School and University Administrators 
  • HRM 042: Early Retirement Incentive Program (University Staff and Medical Center Employees)
  • HRM 047: Provision of Moving and Relocation Assistance for Newly Hired Faculty or Staff
• Medical Center
  • HR 104: Conditions of Employment
  • HR 105: Management Conditions of Appointment
  • HR 106: Orientation of Employees
  • HR 108: Moving & Relocation Assistance - replaced with HRM 047: Provision of Moving and Relocation Assistance for Newly Hired Faculty or Staff
  • HR 201: Employment Categories
  • HR 205: Probationary Period 
  • HR 405: Separation from Employment 
  • HR 407: Reduction in Force
  • HR 901: Employee Referral Incentive Program

• VA Tax Forms
• W-4 Form

Learn new information about the revised 2020 W-4 Form.

Learn more about payroll taxes on the UVA Payroll website.

See the Workday job aid on withholding federal and state elections.

Updating Your W-4 Form - Medical Center

You may update and make changes to your Federal W-4 withholding status online.  This will not only allow you to make immediate changes to your withholding status, but continues our “green” initiative by saving paper and other costs. 

Please note: Changes made prior to the Saturday pay period end will be reflected on the next Friday paycheck.

To access and/or change your Federal W-4 tax information, log in to Workday, click the Pay App, choose Withholding Elections, and follow the steps.  

NOTE: If you are eligible, you may request exemption from FEDERAL tax withholding.  If you check “Exempt,” please be aware that no taxes will be withheld from your payroll checks. 

Forms

• Accident Report - Academic Division (Facilities Management Employees: Do not use this form. Please complete your department's online form)
• Accident Report - Medical Center
• Accident-Injury Report - UPG
• Workers’ Compensation Panel - Academic Division
• Workers' Compensation Panel - Medical Center
• Workers' Compensation Panel - UPG
• Employee Checklist for Workers’ Compensation
• Workers' Compensation Prescription Form - Medical Center

Policies

• HR 512: Workers' Compensation - Medical Center
• HR 513: Transitional Work Program - Medical Center