Accident/Injury Forms
Incident Report Form
Emergency Contact Sheet

Personal Information Forms
Name Change Form
Address Change Form
Personal Information Sheet - New Employees

Evaluation Forms
Operating Staff Performance Review Process
Operating Staff Performance Review & Goal Development Form
PAT Performance Review & Goal Development Form
Performance Management Guidelines

PDQ Forms
OS PDQ Form
PAT PDQ Form
PAT PDQ Supplement
PDQ Change Form

Appointment, Benefit, and Financial Forms
Exit Interview Questionnaire
Mailing Label/Employee List Request Form
Appointment Request Form — Hourly Appointments
Appointment Request Form — Salaried Appointments
Appointment Request Form — Student Appointments
Bonus Request Form
Direct Deposit NET PAY Form
Direct Deposit FIXED AMOUNT Form
KSC Request for Additional Pay for Administrative Stipend or Adjunct Appointment Duties

Compassionate Leave Forms
Compassionate Leave Policy
Compassionate Leave Verification
Compassionate Leave Donation

Medical Leave Forms
Family/Medical Leave Request
FMLA Certification of Health Provider
Authorization for Release of Information (HIPAA)

Professional Development Forms
Operating Staff Professional Dvt. Fund Application
Operating Staff Professional Dvt. Fund Guidelines

Search Forms
Search Applicant Progress Chart (Goldenrod)

USNH Forms
USNH Volunteer Appointment Letter

The following forms must be picked up at Human Resources:

Keene State College Search Approval Form
Advertising Information Requisition Form(2)
Candidate Recommendation/Rejection Matrix for All Interviewees
EBPA Medical Claim Form
Faculty/Staff Non-Credit Tuition Waiver Form
Faculty/Staff Tuition Waiver Form
Healthsource Point of Service Claim Form (Out of network care only)

*All forms requiring signatures must be printed out, signed and sent to the appropriate department. Please call Human Resources at 358-2877 with any questions.