HR Forms

If you have new hire paperwork related questions for part-time staff, please contact Sergine Louis, Jacky Yu for adjunct faculty, or Melanie Louie for classified staff.

For full-time staff, please reach out to Elma Cruz. General inquiries may be directed to Human Resources

• All Employees Payroll Forms

Secondary

• Full-Time
• Part-Time Instructional
• Part-Time Classified

All Employee Individual forms

• CUNY Policy Checklist for New Hires
• Workplace Violence and Sexual Harassment Prevention New Hire Acknowledgment
• IT Security New Employee Acknowledgment
• Employment Eligibility Verification (Form I-9)
• Personal Data
• Oath of Allegiance
• Federal Tax Form (W-4)
• State Certificate of Tax Withholding (IT-2104)
• Emergency Evacuation
• Direct Deposit
• Paycheck Receipt
• Self Identification (optional)
• CUNY Employment Application Part 1
• CUNY Employment Application Part 2
• CUNY Employment Application Part 3, Public Service Pension
• CUNY Employment Application Part 4, Addendum License and Professional Registration

Classified Employees Only

• Classified Staff New Hire Memo
• Report of External Employment for Classified Staff

Instructional Staff Only

• PSC-CUNY Death Benefit Designation of Beneficiary Card (full-time instructional and benefit eligible continuing education teachers only)
• Retirement Program Election Form
• TIAA Multiple Position Form (for full-time TIAA retirement annuity participants working in a part-time instructional capacity. This is notification for the part-time payroll position to be pensionable.)

Additional Forms, if Applicable

• New Employee Tax Compliance Notification Sheet (SPRINTAX)
• Student Employee Guide – FICA Tax Exemptions
• Adjunct Workload Reporting

If you have any benefits related questions, please contact Joan Albayrak.

Health Benefits

• Health Benefits Enrollment Application (ERB)

Supplemental Health Benefits

• PSC-CUNY WF Enrollment
• PSC-CUNY WF Benefits Application for Domestic Partners
• PSC-CUNY WF Death Beneficiary Designation
• DC-37 Enrollment Application
• DC-37 Short-Term Disability Benefit Claim

Flexible Spending Account (FSA)

• Health Benefits Buy Out Waiver (2024)
• HCFSA/DeCAP Enrollment/Change Form (2024)

FSA Claims Forms

Please direct all inquiries/correspondence and claims as follows:
1) Inquiries and questions can be sent via email to the Program.
2) Forms/documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Plan Year 2023

• 2023 DeCAP Claims Form
• 2023 HCFSA Claims Form

Adjunct Health Benefits

• Adjunct Enrollment Packet
• Health Benefits Enrollment Application (ERB)
• PSC-CUNY Welfare Fund Adjunct Enrollment
• PSC-CUNY Welfare Fund Adjunct Family Enrollment Supplement (for family coverage under the PSC CUNY WF only)
• Adjunct Health Insurance Certification
• Adjunct Health Insurance Verification
• Adjunct Recurring Payment Election (for a NYC health plan that requires a premium only)

Edenred Transit Benefit

• Transit Benefit Enrollment
• Park-N-Ride Plan
• Access-A-Ride/Paratransit Plan

Tuition Waiver

• Tuition Waiver 

Retirement

• TIAA: Salary Reduction Agreement (SRA)
• Pension Election Form
• Application for Terminal Leave Form (Classified Staff)
• Application for Retirement Leave (Travia)
• Retiree Health Benefits Enrollment Application (ERB)
• PSC-CUNY Retiree Enrollment
• PSC-CUNY Retiree SilverScript Enrollment (2024)
• Retiree Change of Address
• Retiree Email Request
• TIAA Medicare Part B Premium Reimbursement
• NYCERS Medicare Part B Premium Reimbursement Notice

Family Medical and Leave Act (FMLA)

• CUNY FMLA Request
• CUNY Certification of Health Care Provider Form for Employees Serious Health Condition
• CUNY Certification of Health Care Provider Form for Family Member’s Serious Health Condition
• CUNY Certification of Family Relationship
• CUNY Certification of Health Care Provider Form for Serious Injury or Illness of a Veteran – Military Caregiver Leave
• CUNY Certification of Health Care Provider Form for Serious Injury of Illness of a Current Service member  – Military Family Leave
• CUNY Certification of Qualifying Exigency for Military Family Leave
• CUNY Notice of Eligibility and Rights and Responsibilities
• CUNY Designation Notice
• CUNY Fitness-For-Duty Certification
• HIPAA Medical Records Release Authorization Form

Non-FMLA Medical Leave

• CUNY Application for Non-FMLA Medical Leave
• CUNY Non-FMLA Medical Leave Designation
• CUNY Fitness-For-Duty Certification
• HIPAA Medical Records Release Authorization Form

Paid Family Leave

Classified Staff

• Statement of Rights for Paid Family Leave
• Insurance Coverage Notice to Employees
• List of Titles Covered By PFL
• Waiver Notice
• Claim Form: Bonding with Children
• Claim Form: Care for Family Member
• Claim Form: Military

PSC Staff

• Statement of Rights for Paid Family Leave
• Insurance Coverage Notice to Employees
• Waiver Notice
• Paid Family Leave Guidelines for PSC Represented Employees
• Claim Form: Bonding with Children
• Claim Form: Care for Family Member
• Claim Form: Military

Parental Leave

• Paid Parental Leave Policy
• Paid Parental Leave Application
• Annual Leave Request for Child Care Purposes
• Application for Special Leave for Child Care (Unpaid) – Instructional Staff only

Reasonable Accommodation

• CUNY Procedures for Implementing Reasonable Accommodations and Academic Adjustments
• Baruch College Reasonable Accommodation Request – Employees and Visitors
• Baruch College Reasonable Accommodation Healthcare Provider
• HIPAA Medical Records Release Authorization Form

Workers’ Compensation

• DP2002 Form – Employee Election
• Employee report
• Supervisor report
• Witness statement
• WC Insurance Employer Coverage

Dedicated Sick Leave Program

• Application to Donate
• Application to Receive
• Policy and Procedures

Catastrophic Sick Leave Program

• Application to Donate
• Application to Receive
• Application to Change/Withdraw Donation
• Policy and Procedures

If you have any payroll related questions, please contact the team at baruchpayroll@baruch.cuny.edu.

Time and Leave

• Application for Leave for Special Purposes – for use when taking jury duty or bereavement leave
• Application for Special Leave for Special Purposes – for instructional staff with personal emergencies of not more than 10 working days may be granted with pay

Payroll

• Federal Tax Form (W-4) – for Federal taxes
• State Certificate of Tax Withholding (IT-2104) – for NY State taxes
• State Certificate of Non-residence and Allocation of Withholding Tax (IT 2104.1) – for employees who do not reside in NY
• State Certificate of Exemption from Withholding (IT-2104E)  –  for any resident who wants to claim exemption from state/city tax. The criteria are listed on the form that must be met to qualify for exemption
• Paycheck Receipt
• Direct Deposit
• Exemption from Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual (8233) – for nonresident aliens only who want to claim exemption from federal and state/city taxes.
• Exemption from Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual Instructions

Requests

• Employment Verification
• Payment Inquiry
• Request for Duplicate W-2
• Request for Pay Stubs
• Request for Replacement Check

If you have HR Information Systems (HRIS) related questions, please contact Max Ng.

HCM Access Form
HR Reporting Access Request Form

If you have any questions about records, please email Human Resources.

• Employment Verification
• Schedule a File Review