In an effort to provide forms that are both functional and cross-platform compatible, we have chosen to use the Adobe Acrobat application. You may need to download or upgrade the free Adobe Acrobat Reader.
Accident Witness Statement – Completed by individuals who witness on-the-job accidents.
Employee’s Report of Injury – Employees complete this form following a work-related injury.
Supervisor’s Accident Investigation – Supervisors complete this form when one of their employees is injured on-the-job. This investigation is to be completed within three days of the injury. (If you a need a copy, please check the “Send me a copy of my responses” box at the bottom prior to clicking Submit.)
Shared Sick Leave Program
FMLA Request Form (Form A) – Required of an employee when requesting to be placed on Family Medical Leave (FML)
Certification of Healthcare Provider (Form B) (Revised 8/2021) – Required from an attending physician to verify an employee’s serious illness
Certification of Healthcare Provider for Family Members (Form C) (Revised 8/2021) – Required for a family member’s serious health condition
Intent to Return to Work (Form D) – Completed by the department and sent to the employee on the tenth (10) week of employee using Family Medical Leave
Medical Evaluation to Return to Work (Form E) – Required to determine the eligibility of the employee to return to work following a serious health condition
FML Designation/Approval Form (Form F) – Required of management to notify Human Resources (Benefits) of approval of FMLA when no certification is required
Extension for Faculty FML (Form G) – Required of a faculty member to request permission to extend the probationary period, the faculty member shall complete the following form
Qualifying Exigency for Military (Form H) – Required for an employee seeking FMLA leave due to a qualifying exigency to submit a certification
Reasonable Accommodation Form – Complete if you are requesting a reasonable accommodation. A majority of this form must be completed by the employee’s physician.
Faculty and Graduate Assistant Background Investigation Request Form – Completing this form will send the candidate the steps to complete a Standard Criminal background check as required for employment at Georgia Southern University. Do NOT use this link if your candidate is being hired through Careers.
Volunteer, Intern and Non-Paid Affiliate Background Check Requests – Email the below information to firstname.lastname@example.org:
- Candidate Name and Email
- Supervisor Name and Email
- Department Name
Staff & Temporary Hiring
G4 Georgia State Tax Form – Complete this form to indicate withholding allowances.
Non-Disclosure Agreement Form – Suggested form to indicate that an employee understands that in the course of your their employment at GSU, they may have access to information that is confidential, proprietary, or sensitive.
Employee Separation Checklist – Form for an employee who has resigned or been terminated.
Supervisor Separation Checklist – Form for a supervisor of an employee who has resigned or been terminated.
Fitness for Duty – Supervisor will complete and fax back this form to Human Resources. This form will include a behavioral description of the circumstances leading to the request for evaluation, and a list of the employee’s relevant duties.
Performance Evaluations – copies of the evaluation forms and further information can be found at this link.
Telework & Flextime Requests – Submit a request or learn more about the electronic request process.
Last updated: 8/3/2023