Forms and Publications
Publications
Forms
Benefits
- Memo: Mandatory Employee Contribution for Optional Retirement Program (pdf)
- Flexible Spending Account Form (2013) (pdf)
- Health Benefits Application (pdf)
- Health Benefits Buy-Out Waiver Form (2013) (pdf)
- Tax-Deferred Annuity (TDA) Salary Reduction Agreement (2013) (pdf)
- 2013 Maximum Benefits and Contribution Limits (inluding 403 and 457 plans)
- Delta Enrollment Form (pdf)
- Delta Disenrollment Form (pdf)
Time and Leave
- Leave Request Form (Family and Medical Leave Act) (pdf)
- Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) (pdf)
- Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) (pdf)
- Certification for Serious Injury or CUNY Illness of Covered Service member –for Military Family Leave (Family and Medical Leave Act) (pdf)
- FMLA Response Form (pdf)
- Certification of Qualifying Exigency for Military Family Leave (Family and Medical Leave Act) (pdf)
- Application to Dedicate Annual/Sick Leave (pdf)
- Application to Receive Dedicated Annual/Sick Leave (pdf)
- Application for Paid Parental Leave (pdf)
- Application for Special Leave for Child Care (pdf)
- Annual Leave Request Form (pdf)
- Request for College Laboratory Technician Overtime (pdf)
Academic Personnel
- Adjunct Workload (pdf)
- Educational Background (pdf)
- End of Service (pdf)
- Fellowship Leave (pdf)
- Scholar Incentive Award (pdf)
- Overload Appointment Form (HEOs and CLTs) (pdf)
Multiple Position Policy and Forms
- Multiple Position Policy including Summary (pdf)
- Proportional Hours Calculator (Excel)
- TIAA-CREF Multiple Position Form (pdf )
Multiple Position Reporting is now done only via the WebCentral Portal (https://portal.brooklyn.edu/). Look for Multiple Position Reporting under the “My Info” tab.
Payroll/Tax
- College Assistant/Student Aide Time Sheet (pdf)
- Direct Deposit (pdf)
- Non-Teaching Adjunct Time Sheet (pdf)
- Tax: Federal (W-4) (pdf)
- Tax: New York State/New York City (IT-2104) (pdf)
- Tax: New York State/New York City (IT-2104-E (exempt)) (pdf)
- Workload Reporting Form (pdf)
Training and Development
- CUNY OHRM Professional Development and Learning Management Office Training Application (pdf)
- DCAS CTC Training Application (pdf)
- HEO Evaluation (pdf)
- Request for Professional Development Funds (HEO/CLT) (pdf)
Other Forms
- CUNY Employment Application (pdf)
- Amended Constitutional Oath (pdf)
- Basic Personnel & Address Information (pdf)
- I-9 (pdf)
- Performance Evaluation Form for Classified Staff (pdf)
- College Assistant Reappointment (pdf)
- Form 210 (pdf)
New Employee Information Packet and Forms
- Executive Compensation Plan (ECP) Packet (pdf)
- ECP Terms and Conditions (pdf)
- Faculty Packet (pdf)
- HEO & CLT Packet (pdf)
If you have any questions, please call 718.951.5161.
