Forms | Division of Human Resources | West Virginia University

Here you can find all the Human Resources forms we have available online for your convenience. Please note that all forms are only accessible if you are inside the WVU firewall, the exception is the Regular Employment forms that can be accessed by anyone with no restrictions.

Some forms may require Acrobat Reader

Employment and Recruitment

Regular Employment

WVU Employment Application and Directions

WVU Position Interest Form

Mountaineer Temps
Mountaineer Temp Application

Mountaineer Temp Job Order Form

Benefits

American International Group (AIG) Accident Insurance
AIG Cancellation Form

Authorization for Release of Information
Authorization for Release of Information Form

How to Change an Address
Change of Address

Child Care Financial Assistance Program
Child Care Financial Assistance Application

Employee Leave
Annual Leave Extension Request Form
Request for Personal Leave of Absence

Optional/Dependent Life Insurance
PEIA Optional/Dependent Life Insurance Enrollment Form
PEIA Basic and/or Optional Life Insurance Change of Beneficiary Form

Other Qualified Adults
WVU Employee Benefits Dependent Identification Card Application Form

Health Insurance (PEIA and Health Plan)
PEIA Change-in-Status Form
PEIA Change of Beneficiary Form
PEIA Out-of-Area Dependent Form
Student Verification Form
PEIA Medical Claim Form (form needed for reimbursement of payment for flu vaccine)
PEIA Tobacco Affidavit
Dependent Ineligibility Affidavit
PEIA Plans A, B, and C Advance Directives Forms
WV Living Will
WV Medical Power of Attorney
WV Living Will & Medical Power of Attorney Combined

Mountaineer Flexible Benefits (dental, vision, flexible spending accounts, etc.)
FBMC Change-in-Status Form
FBMC FSA Claim Form
Delta Dental Claim Form

Retirement – TIAA-CREF
TIAA-CREF Change of Beneficiary Form
TIAA-CREF Name Change Form
TIAA-CREF Change in Allocation Form (send completed form directly to TIAA-CREF)
TIAA-CREF 401(a) Enrollment Form – In addition, please submit a
401(a) Vendor Selection Authorization with enrollment
TIAA CREF 403(b) Enrollment Form – must include
SRA Salary Reduction Agreement 403(b)-457(b) with enrollment
TIAA CREF 457(b) Enrollment Form – must include
SRA Salary Reduction Agreement 403(b)-457(b) with enrollment

Retirement – Great West
Great West 401(a) Enrollment Form – In addition, please submit a
401(a) Vendor Selection Authorization with enrollment
Great West 403(b) Enrollment Form – must include
SRA Salary Reduction Agreement 403(b)-457(b) with enrollment
Great West 457(b) Enrollment Form – must include
SRA Salary Reduction Agreement 403(b)-457(b) with enrollment

Supplemental Retirement Annuities (SRA)
SRA Salary Reduction Agreement 403(b)-457(b)
Non-Benefits Eligible Salary Reduction Agreement 403(b) ONLY

Retiree Insurance
PEIA Retiree Health Benefits and Basic Life Enrollment Form
PEIA Retiree Optional/Dependent Life Enrollment Form
WVU Retiree Medicare Information Letter
FBMC Retiree Mountaineer Flexible Benefits Enrollment Form

Sick Leave Buyout Program
Application for Payment of Unused Sick Leave
Sick Leave Buyout Program Tax Forms

WVU Long-Term Disability
WVU Long-Term Disability Cancellation Form

Years of Service
Request for Years of Service Verification
Retiree Accrued Leave-YOS Conversion Form

Classification and Compensation Forms and Resources/Information

Immigration Wage Forms
Permanent Residency Wage Packet
H-1B Wage Packet
Interim Agreements
Informational memo to EBOs on interim agreements
Interim agreement form
Resume attachment form for WVU PIQ review
Memo Template for Interim Appointments

Position and Personnel Action Forms and Information

Classified PIQ Forms:
Position Information Questionnaire (PIQ) – Cover Sheet Instructions
PIQ – Cover Sheet
PIQ Form
PIQ Training Handout
PIQ Tutorial Presentation

Non-Classified and FEAP (Faculty Equivalent/Academic Professional) Job Description Forms:
NC FEAP Cover Sheet-Main
NC FE/AP Cover Sheet-WVUP
NCFEAP Form