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

VRS Forms

• Election to Participate
• VRS Hybrid Forms Website

Life and AD&D Insurance

• 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 Life Beneficiary 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

• HR 401: Pay Administration - Medical Center
• HR 402: Compliance with The Fair Labor Standards Act - Medical Center 
• Sign-On Bonus Agreement Form and Policy

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

Forms

• Alternative Work Schedules
• Career Development
• Compensation Program for University Staff Employees
• Drafting Telecommuting Plan
• Managing Short-Term Wage Employment
• Moving & Relocation Expense Summary - Medical Center
• Moving and Relocation Reimbursement Guide - Medical Center
• Probationary Period for University Staff Employees
• Professional Service and External Consulting for University Staff Employees
• Request for Exception from Policy 401 - Medical Center
• Safety Checklist for Telecommuting
• Telecommuting From Alternative Work Locations
• Telecommuting Needs Assessment
• 1. Telecommuting Plan Sample (Word document downloads bottom of screen)
• 2. Telecommuting Plan Sample (PDF opens in browser)
• Terms and Conditions of University Staff Employment
• Travel Time Guidelines for Non-Exempt Staff
• University Staff Employees Engaged in Teaching

Policies

• HR 104: Conditions of Employment - Medical Center
• HR 105: Management Conditions of Appointment - Medical Center
• HR 106: Orientation of Employees - Medical Center
• HR 108: Moving & Relocation Assistance - Medical Center
• HR 301: Educational Assistance - Medical Center
• HR 502: Work Hours and Schedules - Medical Center
• HR 503: Telecommuting From Alternative Work Locations - Medical Center
• HR 510: Emergency Event Declarations - Medical Center
• HR 706: Supervision of Relatives - Medical Center
• HR 707: Violations of Confidentiality - Medical Center
• HR 901: Employee Referral Incentive Program - Medical Center
• HR 905: Health Care Provider Licensure/Certification Policy - Medical Center
• HR 910: Campaigning for and Serving in Public Office - Medical Center

• Attendance Policy Addendum Template - Medical Center
• Faculty Salaried Personnel Hire Form
• Faculty Wage/Student Personnel Hire Form
• HR 109: Personnel Records - Medical Center
• Knowledge Transfer Template
• Name & Address Change Form - Medical Center - Please make changes through Workday
• Offboarding Checklist
• Removal of Access Privileges and Return of UVa MC Property

• Authorization Agreement for Automatic Check Deposit (ACH) Credits - Medical Center
• FICA Release Letter
• Off-Cycle Payroll Request
• Payroll Adjustment Form - Medical Center
• Time Management Form
• Time Management Form Shift Work

Forms

• Academic Emergency & Disaster Leave Form
• Academic Leave Sharing Donor Application
• Academic Leave Sharing Recipient Application
• Medical Center Military Leave Request Form
• Medical Center PTO Donation Form
• Medical Center PTO Donation Request Form
• Paid Parental Leave Request forms and policies:
  • Classified Staff Paid Parental Leave Request Form
  • Health System Paid Parental Leave Request Form
  • University Staff Paid Parental Leave Request Form
  • UPG Paid Parental Leave Form
  • UPG Paid Parental Leave Policy
• Personal and Educational Leave Request Form
• University Physicians Group Paid Time Off Policy
• University Physicians Group Civil Leave Policy
• University Physicians Group FMLA Policy
• Request for Family and Medical Leave - Medical Center
• Request for Medical Leave - Medical Center
• Request for Overtime Leave Payment
• Recognition Award Request

Policies

• HR 315: Paid Time Off - Medical Center
• HR 600: Leaves of Absence - Medical Center

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 Progress Review/Extension/Completion Form
• Team Member Performance Improvement Plan Guideline - Medical Center
• Team Member Performance Improvement Plan (TPIP)

Policies

• HR 106: Promotions, Demotions, and Transfers - Medical Center
• HR 205: Probationary Period - Medical Center
• HR 209: Performance Management Program - Medical Center
• HR 210: Competency Assessment - Medical Center
• HR 702: Fitness for Duty - Medical Center
• HR 704: Attendance - Medical Center
• HR 806: Employee Rewards and Recognition Programs - Medical Center

Policies

• Affirmative Action - EOCR
• Behavioral Interviewing Guide
• Candidate Reference Check
• Dual Employment Request
• EOCR Search Committee Training
• EOCR Recruitment and Hiring Resource Guide
• EOCR Posting and Training Requirements
• Hiring and Recruiting Individuals with Disabilities
• Job Catalog Details Report (Replaces Title Summary Tool)
• Move Agreement Form
• Position Description Degree Requirement Analysis worksheet
• Recruitment and Hiring of University Staff and Wage Employees
• Remote Hire Notice Form
• Reassignment Request Form
• Sample Candidate Reference Check For Guidance
• Virginia Workforce Center Flyer
• Virginia Department of Rehabilitative Services Quick Reference Resources

Forms

• HR 201: Employment Categories - Medical Center
• HR 405 - Separation from Employment - Medical Center
• HR 407 - Reduction in Force - Medical Center

• VA Tax Forms
• W-4 Form

Click here to 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, login 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

• DHRM 4.60 - Academic Division Classified and University Staff
• HR 512: Workers' Compensation - Medical Center
• HR 513: Transitional Work Program - Medical Center
• HRM 038: Faculty Leave 
• Worker's Compensation Policy - UPG