Forms

Frequently Requested

HR 19-Permission to Take a Course	Policy Form 19 Procedures	Request Electronic Form
Form 9- Permission to Engage in Outside Employment	Policy FAQ for Form 9	Request Electronic Form
Reasonable Suspicion Record Form	Policy	PDF Document
Form 13-S Supplement to Electronic Form HR 13		Link

Benefit Related

(health insurance, leave, worker’s compensation)

Benefits Change of Address Form (Please use myOleMiss to make address changes.  This form is to be used only if you do not have access to myOleMiss.)		PDF Document
UNUM Beneficiary Designation Form		PDF Document
State Life Insurance Beneficiary Designation		PDF Document
AD&D Beneficiary Designation Form		PDF Document
Insurance Claim Form for Delta Dental		Link
Insurance Claim Form for Davis Vision		PDF Document
Insurance Claim Form for Colonial Life and Accident		Link
Insurance Claim Form for American Heritage Cancer and Intensive Care		PDF Document
Insurance Claim Form for Medical Claim		PDF Document
Mail Order Prescriptions		PDF Document
Request for Reimbursement Form for Flexible Spending Accounts with Southern Administrators & Benefit Consultants		PDF Document
Dependent Care Receipt Form		Link
Change of Information for the Public Employees’ Retirement System		PDF Document
Public Employees’ Retirement System of MS Beneficiary Designation Form		PDF Document
Workers Compensation Injury Report Packet		PDF Document
Medical Certification Form		PDF Document
Reasonable Suspicion Form		PDF Document

E-form Administration

E-form program on myOleMiss		Link
E-form Guides and Information		Link
Request Access to E-form		Link

Flexible Work Location (Telework & Remote Work)

Flexible Work Location Request	Policy	PDF Document
Flexible Work Location Arrangement Form	Policy	PDF Document
UM Telework IT Checklist		PDF Document

Payroll

Timesheet-Student		Excel Document
Timesheet-Non Exempt/Hourly		Excel Document
Timesheet-Exempt/Salary		Excel Document
Timesheet-Rebel Reserve		Excel Document
Payroll Time Conversion Chart		PDF Document
Off-Cycle Request Form		PDF Document

Recruitment

For Recruitment related documents and forms, please use your Ole Miss webID and password to login to connectU (connectu.olemiss.edu). These below documents can be found by selecting the “Click Here for connectU Resources” box..

• Search Committee Guide
• Job Requisition Intake Form
• Sample Interview Questions
• Sample Reference Check Questions
• Confidentially Agreement

Separation of Employment

Exit Checklist	Policy	PDF Document
Separation Notification	Policy	PDF Document
Student Exit Checklist		PDF Document

The following  can be accessed at my.olemiss.edu.

• Address Change
• W-2 Opt-In
• W-2
• Pay Stubs
• Timesheets
• Office Contact Information
• Emergency Contact Information
• Bank Information
• Travel
• Benefits Confirmation Statement
• Open Enrollment