Forms

Note: All Virginia Tech employees with a Virginia Tech (@vt.edu) email address have access to the forms provided by Human Resources. If you are an employee, and receive an error when trying to access/download a form, please make sure you are logged in to google with your Virginia Tech email address.

#	Name	Description	Category
P111	Voluntary 403(b) Retirement Contribution Election	Voluntary 403(b) retirement contribution election. Actions: Start, Change or Stop.	Benefits
	Acknowledgement Form (Faculty)	Contains faculty orientation checklist and acknowledgements.	Orientation
	Acknowledgement Form (Staff)	Contains staff orientation checklist and acknowledgements.	Orientation
	Consent to Electronic Delivery	Acknowledgement that employee is willing to receive documents electronically.	Orientation
P141	Acknowledgement of Model Performance	Model performance acknowledgement for classified staff employees.	Performance Management
P142	Notice of Improvement Needed Unsatisfactory Performance	Employee Notice of Unsatisfactory Performance and Improvement Needed Form.	Employee Relations
P149	Manual Check Request Form (Salary, GTA, GRA, GA, P-14)	Request for manual checks. Links to Controller website.	Payroll
P150	Manual Check Request Form (Wage)	Wage employee manual check request form. Links to Controller website.	Payroll
P151	Panel Physician Selection	Acknowledgement of employee review of panel physicians selection.	General
P152	Selective Service Registration Questionnaire	Selective service registration questionnaire (males only)	General
P86	Non-paid Affiliation Appointment	Non-paid affiliation appointment form.	Transactions
P88	Memorandum of Agreement for Educational Leave	Form for faculty to submit to request educational leave.	Provost
	Counseling Memorandum on Performance	Sample performance counseling memorandum form.	Employee Relations
	Counseling Memorandum on Behavior	Sample behavioral counseling memorandum form.	Employee Relations
	Letter Placing an Employee on Leave for Administrative/Civil and Work-Related Leave Pending Internal Investigation	Sample letter placing an employee on leave for administrative/civil and work-related leave pending internal investigation.	Employee Relations
129-01-004	Written Notice	Important information concerning issuing a written notice	Employee Relations
	Resignation Acceptance Letter	Resignation acceptance letter for Virginia Tech employees.	Employee Relations
	Due Process Letter (After Investigation)	Sample Due Process letter to be used when employee has been on pre-disciplinary leave pending investigation.	Employee Relations
	Due Process Letter (No Investigation)	Sample Due Process letter to be used when there is no pending investigation.	Employee Relations
	Letter Terminating Wage Employment	Sample letter terminating wage employment.	Employee Relations
	Letter Terminating Probationary Employment	Sample letter terminating probationary employment.	Employee Relations
	Pre-Disciplinary Leave Letter Pending Standards of Conduct Investigation	Sample letter placing an employee on pre-disciplinary leave pending standards of conduct investigation.	Employee Relations
P188	Memorandum of Agreement and Promissory Note For Tuition Credits	Memorandum of Agreement and Promissory Note for Tuition Credits in Accordance with Tuition Assistance and Reimbursement for Salaried Employees.
17834	Consent To Life Insurance - New York Life Optional Life Insurance	Consent to New York Life Insurance Company - Spouse/Domestic Partner/Parent/Grandparent	Benefits
	Consent For Prospective Supervisor to Review Personnel File	Consent form for employee personnel file to be reviewed by authorized person or agency.	Human Resources
VRS-2	Designation of Beneficiary	Designation of beneficiary form through the Virginia Retirement System.	Benefits
P3A	P3A – Staff and Faculty Actions or Change of Status	Report of staff and faculty actions or change of status.	Human Resources
P4B	Request for Employee Leave	Request for employee leave form. Should be submitted as soon as leave decisions are made.	Human Resources
P6A	Leave Sharing Donor Form	Leave sharing donor form.	Human Resources
P10	Change or Extend Funding	Retroactive Funding Actions, Current/Future Funding Actions, and Organizational Transfers form	Controller
P12B	Change of Name, Address or Social Security Number (SSN)	Form used by employees to change name, address or SSN.	Human Resources
P14A	Part Time Temporary Faculty Appointment Authorization For Payment	Provides wage compensation for part-time temporary faculty-level services in instruction, research, outreach or administration.
P94	Restricted Staff Apointment Acknowledgement	Appointment to a restricted position (classified staff or university staff)	Human Resources
P99	Request for Human Resources Records	Request form to review or receive copies of official personnel records from Human Resources.	Human Resources
P108	Emergency Hire Extension	Emergency hire form for non-student wage employment.	Human Resources
P112	Technical Correction Form	Request to change an employee work profile P112 technical correction. Internal use only.
P120	Personnel Signature Authorization	Human Resources Signature Authorization from the Dean or Vice President of a specified department.	Human Resources
P125	Probationary Progress Review	Employee Probationary Progress Review Form
P146	Request For Extension of Probationary Period	Request form for an extension of probationary period, not exceeded 18 months.	Employee Relations
P153	Request to Establish Employee Award or Recognition Program	Request for to establish employee award or recognition programs. Brief description, participating departments, and funding source.
P154	Employee Recognition Award Payment and Leave Form	Employee Recognition Aware Payment and Leave Form (Prior program approval required)	Benefits
	Return To Work Release	Return to work release form based on evaluation.
	Sheltered Leave / Additional Pay Deferral	Sheltered leave/additional pay defferal form to modify salary as indicated.
SS	Summer Session Teaching Appointments	This form is used for summer session 1 and 2 teaching appointments.
	Summer Sessions Research Appointments	Form used for the summer session research appointments only.
VRS39	Optional Life Insurance - Minnesota Life Application	Enrollment application for VRS optional group life insurance with Minnesota Life Insurance Company
	Staff Checklist	New staff hiring checklist	Human Resources
23830	Mobile Communication Device Procedure	The purpose of this document is to provide guidance and procedures for the effective implementation of the Allowance Payment Option, Option #2 in Policy 3960.	Controller
	Mobile Communication Device Request Form	Employee mobile communication device request form	Controller
	Transcript Cover Sheet for Course Credentialing	Transcript cover sheet for course credentialing for instructors of record.	Provost
P12F	Fellowship Information Supplement	Fellowship information supplement necessary to disburse fellowship payment.	Undergraduate Research
SU	Undergraduate Fellowship Form	Undergraduate fellowship payment record form.	Undergraduate Research
	Volunteer Sample Letter	Volunteer services sample letter including summary of duties and responsibilities.
	Paid Parental Leave Eligibility	Paid Parental Leave Eligibility Application Form	Leave
	VT Retiree's Association Membership	Virginia Tech Retirees Association 2019-2020 Membership form	Human Resources
	FMLA - Certification of Health Care for Employee’s Serious Health Condition
	FMLA - Certification of Health Care for Family Member's Serious Health Condition	Family and Medical Leave Act of 1993 - Employee Packet	Human Resources
	Conviction Check Request	Request conviction and other pre-employment checks.	Human Resources
P6	Leave Sharing Recipient Form	Leave sharing recipient form - reason for leave, estimated length of absence, and rights.	Human Resources
P160	Offer Letter for Part-Time Temporary Wage Appointment	Sample letter for part-time temporary wage appointment. Some information is instructional and you need to put in the appropriate information.
A10385	State Active Enrollment	State health benefits program enrollment form for employees.	Benefits
F52833	Securian Enrollment Form	Enrollment application for VRS optional group life insurance with Securian Financial.	Benefits
	PageUp User Access Request	Form to request access to applicant tracking system, PageUp.	HRIS
	Emeritus or Emerita Status Nomination Form	Form to use to nominate a Virginia Tech faculty member for emeritus/emerita status.	Provost
	Grievance Form: Administrative and Professional Faculty	Form to submit administrative and professional faculty grievances.	Provost
	Grievance: Agreement to Extend Deadline for Response	This form is filed when an agreement is reached to extend the grievance response deadline.	Provost
	Grievance Form: Instructional Faculty	Form to submit instructional faculty grievances.	Provost
	Grievance: Research Faculty	Form to submit research faculty grievances.	Provost
	Modified Duties Request (Provost Office)	This form is filed by tenured and tenured-track faculty with the Provost Office when requesting modified duties.	Provost
	Request to Extend Probationary Period (Tenure/Continued Appointment)	One-year probationary period extension request form for care of a child or other non-professional circumstance.	Provost
	Application for Voluntary Transitional Retirement Program for Tenured Faculty	Form for tenured faculty to apply for the voluntary transitional retirement program.	Provost
P88	Memorandum of Agreement for Research Leave or Special Leave with Pay	Form to request research leave or special leave with pay.	Provost
F53411	Securian Change Form
F52749	Securian Evidence of Insurability
F52729	VRS Certificate of Life Insurance		Benefits
P12W	Wage Employee Appointment Record	Wage employee appointment record form.	Human Resources
	Reappointment Administrative Professional FT Academic Year Regular	Re-appointment terms for AP faculty in full-time academic year regular roles.	Recruiting
	Reappointment Administrative Professional FT Academic Year Restricted	Re-appointment terms for AP faculty in full-time academic year restricted roles.	Recruiting
	Reappointment Administrative Professional FT Calendar Year Regular	Re-appointment terms for AP faculty in full-time calendar year regular roles.	Recruiting
	Reappointment Administrative Professional FT Calendar Year Restricted	Re-appointment terms for AP faculty in full-time calendar year restricted roles.	Recruiting
	Reappointment Administrative Professional PT Calendar Year Regular	Re-appointment terms for AP faculty in part-time calendar year regular roles.	Recruiting
	Reappointment Administrative Professional PT Calendar Year Restricted	Re-appointment terms for AP faculty in part-time calendar year restricted roles.	Recruiting
	Reappointment Research FT Academic Year Restricted	Re-appointment terms for research faculty in full-time academic year restricted roles.	Recruiting
	Reappointment Research FT Calendar Year Restricted	Re-appointment terms for research faculty in full-time calendar year restricted roles.	Recruiting
	Reappointment Research PT Academic Year Restricted	Re-appointment terms for research faculty in part-time academic year restricted roles.	Recruiting
	Reappointment Research PT Calendar Year Restricted	Re-appointment terms for research faculty in part-time calendar year restricted roles.	Recruiting
	Reappointment Teaching & Research FT Academic Year Regular One Year	Re-appointment terms for one year for teaching and research faculty in full-time academic year regular roles.	Recruiting
	Reappointment Teaching & Research FT Calendar Year Regular One Year	Re-appointment terms for one year for teaching and research faculty in full-time calendar year regular roles.	Recruiting
	Reappointment Teaching & Research FT Academic Year Restricted	Re-appointment terms for teaching and research faculty in full-time academic year restricted roles.	Recruiting
	Reappointment Teaching & Research FT Calendar Year Restricted	Re-appointment terms for teaching and research faculty in full-time calendar year restricted roles.	Recruiting
	Reappointment Teaching & Research PT Academic Year Restricted	Re-appointment terms for teaching and research faculty in part-time academic year restricted roles.	Recruiting
	Reappointment Teaching & Research PT Calendar Year Restricted	Re-appointment terms for teaching and research faculty in part-time calendar year restricted roles.	Recruiting
P36	Request for Additional/Outside Employment for Classified or University Staff	This form should be used by classified and university staff members to seek advance approval for additional employment outside of Virginia Tech in accordance with Policy 4070.	Payroll
P126	Memorandum of Agreement for Educational Aid Reimbursement	This memorandum of agreement needs to be completed per University Policy 4800: Tuition Assistance and Reimbursement Program for Salaried Employees	Benefits
N/A	Request for Research - Extended Appointment	This form should be used to request conversion of an academic year (AY) appointment to a 10-, 11-, or 12-month contract.	Provost
N/A	Request for Extension of a Research Extended Appointment	This form should be used to request an extension of an academic year (AY) faculty, who is already appointed to a 10-, 11-, or 12-month contract.	Provost
	Telework/Alternate work schedule agreements and Tuition waiver requests	Online form used to apply for telework or alternative work schedule agreements and to create tuition waiver requests	Benefits
	Recruitment Consultation Request	Complete this form to start recruitment initiation with the HR Recruitment team. Please enter information as thoroughly as possible.	Recruiting
	Orientation Scheduler	Form for self-scheduling an orientation session	Orientation
	Business Conduct Standards acknowledgement form	Form that employees complete during new hire orientation acknowledging Virginia Tech's Business Conduct Standards.	Orientation
	Employee Telework/Remote Work Self-Assessment Questionnaire	Employees should complete this form to determine if their role is suitable for telework/remote work.	Benefits
	Manager Telework/Remote Work Suitability Questionnaire	Managers should complete this form to determine if a role and an employee are suitable for telework/remote work.	Benefits
VRS65	Faculty Election of Retirement Plan		orientation
	Pool Certification Template	This form should be used to certify a faculty pool for a position prior to moving to an job offer.	Recruiting
	Knowledge Transfer Template	This form should be completed by an employee who is transferring to another role or department at Virginia Tech.	Human Resources
	Election to Change Optional Retirement Plan Provider	Change Retirement Plan Provider	Benefits
N/A	Supervisor Transfer Checklist	Form to be completed by supervisor when employee transfers to another university role.	Human Resources
N/A	Supervisor Offboarding Checklist	Form to be completed by supervisor when employee separates from the university.	Human Resources
N/A	Employee Transfer Checklist	Form to be completed by employee when they transfer to another role at the university.	Human Resources
N/A	Employee Offboarding Checklist	Form to be completed by employee when they separate from the university.	Human Resources
139	Physical Capabilities Form		Benefits
N/A	Offer Letter Example - Regular Staff	Example offer letter for regular staff hire.	Recruiting
N/A	Offer Letter Example - Restricted Staff	Example offer letter for restricted staff hire.	Recruiting
N/A	Offer Letter Example - A/P Faculty	Example offer letter for A/P faculty hire.	Recruiting
N/A	Offer Letter Example - Non-tenure track faculty	Example offer letter for non-tenure track faculty.	Recruiting
N/A	Offer Letter Example - Tenured faculty	Example offer letter for tenured faculty hire.	Recruiting
N/A	Offer Letter Example - Tenure track faculty	Example offer letter for tenure track faculty hire.	Recruiting
N/A	Offer Letter Example - Research Faculty	Example offer letter for research faculty hire.	Recruiting

North End Center, Suite 2300 (0318)
300 Turner Street NW
Blacksburg, VA 24061

Hours 8 a.m.-5 p.m.
Phone 540-231-9331
Fax 540-231-3830
Email hrservicecenter@vt.edu
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