Forms

All forms are PDF and open in a new window unless otherwise indicated. Please open with Adobe Acrobat to use fillable form functionality. Scroll down for all form categories. This document [or form, agreement, etc.]  may be executed in any number of counterparts, each of which may be deemed an original, but all of which shall constitute one and the same instrument. Electronic, facsimile or PDF signatures shall be deemed to constitute original signatures for all lawful purposes.

Forms Used in the Hiring Process

To Be Completed by Hiring Managers

• Background Check Procedures - Please notify your candidate that Human Resources will be sending an electronic invite to the email address we have on file for them from Sterling InfoSystems.  Please contact Human Resources if your candidate does not have an email address.
• Temporary Employees Employment/Termination Form

To be Completed by Employees (HR will email a New Employee Package tailored to your position upon completion of a successful background check)

• New Employee Registration Form (No Benefits)
• New Affiliated Member Form (Non-employee)
• I-9 Form - This form must be completed in person with original, valid forms of identification.  Please contact Human Resources with any questions.
• W4, Federal Tax form
  • Not sure what to claim? Try the IRS Withholding Calculator
• IT-4, State of Ohio Tax Form
• City of Mount Vernon Tax Form
• Direct Deposit Authorization Form
• Acknowledgment Form; Receipt of Notices, Handbooks, and Other Disclosures via Electronic Media

Benefit Enrollment/Change Forms

If you have recently become benefits eligible and need to select enrollment for all Kenyon Benefits, please select the Benefits Enrollment Package for a single, convenient form.

• Benefits Enrollment Package

Singular Enrollment Forms:

• Flexible Spending Election Form - This form must be completed each year in order to enroll
• Steelworkers Health and Welfare Enrollment/Change Form - For Collectively Bargained Skilled Trades
• UMR Health/Dental Enrollment/Change Form
• Domestic Partner Information and Certification
• Domestic Partner Termination Form
• Optional Life and Personal Accident Insurance Enrollment Form along with Beneficiary Changes
   
  • Form for Beneficiary Change Only
  • Evidence of Insurability Form (English) for Requests Above Guaranteed Amount
    
  • Evidence of Insurability Form (Spanish) for Requests Above Guaranteed Amount
• Additional Contribution to Emeriti; Voluntary Salary Deduction Agreement
• TIAA Retirement Plan Contribution Form
• TIAA - Kenyon Microsite
• TIAA - Trusted Contact Form
• How to Enroll Online and Manage Your Account
• Verification of Retirement Eligibility
• Housing Request Form (For Faculty and Eligible Staff)

 Reimbursement Request Forms

• Travel Expense Form
• Moving Expense Reimbursement Policy and Form
• Accounts Payable Forms
• Emeriti Qualified Medical Expense Reimbursement Form
• Flexible Spending Request for Health Care Reimbursement Form (UMR) pdf
• Flexible Spending Request for Health Care Reimbursement Form (UMR) word
• Flexible Spending Request for Dependent Care Reimbursement Form (UMR) pdf
• Flexible Spending Request for Dependent Care Reimbursement Form (UMR) word
• UMR Health and Dental Claim Form

Review/Position Description Forms

• NEW! Development Planner and Tracker - Excel
• Position Description Questionnaire Non Exempt Staff-pdf
• Position Description Questionnaire Non Exempt Staff - word
• Kenyon Job Description Template

Other Forms

OptumRx mail order prescriptions

• Home Delivery Order Form. 
• Home Delivery Order Form Bilingual. 

Worker's Compensation Forms

• Injury Reporting Kit
• Report of Work-Related Incident/Injury

Family and Medical Leave Act (FMLA) Forms

• Contact Human Resources for Eligibility, Rights, and Responsibilities
• FMLA Employee Guide
• Certification of Health Care Provider for Employee's Serious Health Condition
• Certification of Health Care Provider for Family Member's Serious Health Condition
• Certification of Qualification Exigency for Military Family Leave
• Certification for Serious Injury or Illness of Covered Servicemember - for Military Family Leave

SiCK, PERSONAL, Family (SPF) LEAVE FORMS

• Sick, Personal, Family Leave Donation and Acceptance Form Person-to-Person Option
• Sick, Personal, Family Leave Donation and Acceptance Form Community Leave Bank Option