Forms

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.

Benefits

Worker’s Comp

• 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.)
• GA Activity Analysis
• 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.

Shared Sick Leave Program

• Sick Leave Program Enrollment Form 
• Sick Leave Program Request Form 
• Shared Sick Leave Member Termination Form 

FMLA Forms

• 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.

Compensation Administration

Talent Acquisition

Background Check/Investigation Requests

• 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 hrservice@georgiasouthern.edu:
  • Candidate Name and Email
  • Supervisor Name and Email
  • Department Name

Staff and Temporary Hiring

Staff & Temporary Hiring Manager Checklist

Student Hiring

Student Hiring Manager Checklist

Employee Relations

• Human Resources Incident Report
• Disciplinary Action Form

Other Forms

• Employee Separation Checklists – Checklists for employees who have resigned, been terminated, or are transferring to another department in the university.
• Exit Questionnaire
• 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.
• Personnel Action Form –  Form to be completed when any personnel changes or actions are made.
  →Personnel Action Form Instruction Manual Link
• Telework & Flextime Requests – Submit a request or learn more about the electronic request process.

Last updated: 3/19/2025