Human Resources Management and Development

Forms

Work Place Injury Reporting

Report all emergencies to the University Police at 317-940-9999
Accident/Injury Form (PDF)
Injury on Job Procedure (PDF)
U.S.HeatlhWorks locations and hours (PDF)

Report Non-employee injuries (including students, visitors, alumni, or contracted employees)to University Police Department 317-940-9396

Family & Medical Leave Act

NOTE:  the staff process to apply for and to report FMLA has changed effective January 1, 2014

Staff applying for FMLA must speak with their supervisor then contact CareWorks USA 1-888-436-9530 to obtain an application for FMLA and a Medical Certification form. 

Faculty applying for FMLA  must contact Human Resources to apply for FMLA.  JH-144 x9355 

Faculty Request for FMLA form (PDF)
Faculty Medical Certification of Health Care Provider (PDF)
Faculty Fitness for Duty (PDF)

Affiliate Forms

Request for Affiliate ID Form (PDF)
Code of Responsibility Form  (PDF)

General Employment

Address/Name Change (PDF)
Direct Deposit (PDF)
Part-time Faculty Form (DOC) with field drop down menus
Pay Schedule (PDF)
Faculty / Staff Status Form (DOC) with field drop down menus

New Hire  - * These documents are moving to a new link on the HR website "New Hire Documents and Information".

New Hire Application (PDF)

New Employee Information (PDF)
I-9 Employment Eligibility Form(I-9) (PDF) (Rev. 03/08/13 most recent version)
Federal Tax Form(W-4)  (PDF)
State Tax Form(WH-4)  (PDF)
Direct Deposit Instructions (PDF)

Code of Responsibility (PDF)

Performance Management Tools

Performance Evaluation Summary (DOC)
Performance Evaluation Summary - Sample (DOC)
Performance Management Guide (DOC)
Self Evaluation (DOC)

Recruiting

Position Request Form page 1 of 2 (DOC)
Position Justification Form page 2 of 2  (DOC)

NEWS

More news

Human Resources Management & Development

4600 Sunset Avenue
Jordan Hall, Room 144
Indianapolis, IN 46208
(317) 940-9355
(800) 368-6852 ext. 9355
HR Assistant: Sherri A. Heidenreich
sheidenr@butler.edu