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Human Resources

Human Resources Forms


2011 Anthem Information
Anthem General Mail Order Form (For KeyCare, BlueCare & HealthKeepers)
Anthem Customer Claim Form
Anthem Enrollment Form
Anthem HealthKeepers Vision Claim Form
Anthem Member Change Form
Anthem Vision Services Claim Form (For KeyCare & BlueCare)

2011 Optima Information
Optima Enrollment Form
Prescription Home Delivery Order Form (For Optima)

2011 Delta Dental Information
Delta Dental Change Form
Delta Dental Claim/Pre-Authorization Form

2011 MetLife Information
Metlife Enrollment Form

Blue Cross Blue Shield Prescription Drug Program Direct Reimbursement Claim Form
Blue View Out-of-Network Claim Form
Change of Address
Federal Income Tax Withholding Allowance Certificate
Flexible Spending Account Enrollment Form
Flexible Spending Account Reimbursement Request Form
2010 GSRA Salary Reduction Agreement
Personal Information Form
Statement of Health Form
TIAA/CREF Authorization to Change Address
TIAA/CREF Group Supplemental Retirement Annuity Enrollment
Virginia Income Tax Withholding Exemption


Position Description
Promotion Forms

Employee Relations

Employee Recognition
Probationary Performance Appraisal Form (doc, pdf)
Casual Performance Appraisal Form (rtf, pdf)
Performance Improvement Plan
PIP Completion Form
Corrective Action Form
Conflict of Interest Disclosure


Affirmative Action Form
Affirmative Action Form for Veteran Status
Employment Interviewee Evaluation
JLab Employment Application
Recommendation to Hire

International Relations

Online Registration Forms
Visitor Insurance Forms (policies, claim forms, HIPPA, enrollment, provider info, premiums)
Visa Forms (J-1information sheet, J-1 orientation, J-1 visa form)
Social Security Forms

Performance Appraisal

Performance Improvement Plan
PIP Completion Form
Matrixed staffing process
Matrixed staffing quick reference


JSA Educational Reimbursement Program Application (HR Form 302.00)
JSA Educational Reimbursement Program Payment Request (HR Form 303.00)
JSA Job-Related Training Request - (HR Form 303.02)
Print and send only when a Travel Authorization (TA) is not involved. When a TA is involved, save the completed form and attach to the TA.
Mentoring Work Plan
Check Disbursement Form


J-1 Visa Form