Virginia Tech | Human Resources | HR Forms

P86 Non-paid Affiliation Appointment (PDF) New Non-paid affiliation appointment form.

Employee Administration

04/07 N/A Counseling Memorandum on Performance (DOC) Sample performance counseling memorandum form

Employee Relations

03/09/26 N/A Counseling Memorandum on Behavior (DOC) Sample behavioral counseling memorandum form.

Employee Relations

03/09/26 N/A Letter Placing an Employee on Leave for Administrative/Civil and Work-Related Leave Pending Internal Investigation (DOC) Sample letter placing an employee on leave for administrative/civil and work-related leave pending internal investigation.

Employee Relations

03/09/26 129-01-004 Written Notice (DOC) New Important information concerning issuing a written notice. This link will take the user to the DHRM form.

Employee Relations

04/08 N/A Resignation Acceptance Letter (DOC) Resignation acceptance letter for Virginia Tech employees from department/supervisor

Employee Relations

03/09/26 N/A Intent Letter For Due Process (After Investigation) (DOC) Sample intent letter to be used for due process meeting following an investigation

Employee Relations

03/19/26 N/A Intent Letter For Due Process (No Investigation) (DOC) Sample intent letter to be used for due process meeting (no investigation)

Employee Relations

03/19/26 N/A Letter Terminating Wage Employment (DOC) Sample letter terminating wage employment.

Employee Relations

03/09/26 N/A Letter Terminating Probationary Employment (DOC) Sample letter terminating probationary employment.

Employee Relations

03/09/26 N/A Pre-Disciplinary Leave Letter Pending Standards of Conduct Investigation (DOC) Sample letter placing an employee on pre-disciplinary leave pending standards of conduct investigation

Employee Relations

03/09/26 P188 Memorandum of Agreement and Promissory Note For Tuition Credits (PDF) New Memorandum of Agreement and Promissory Note for Tuition Credits in Accordance with Policy 4800, Tuition Benefits Program for Salaried Employees.

Benefits

04/08 N/A Consent For Prospective Supervisor to Review Personnel File (PDF) New Consent form for employee personnel file to be reviewed by authorized person or agency.

Employee Administration

04/07 P3A P3A – Staff and Faculty Actions or Change of Status (PDF) New Report of staff and faculty actions or change of status. Please submit this document to Human Resources via the P3A form Service Request: https://vthr.teamdynamix.com/TDClient/1820/Portal/Requests/ServiceDet?ID=54927%20

Employee Administration

04/07 P4B Request for Employee Leave (PDF) New Request for employee leave form. Should be submitted as soon as leave decisions are made.

Human Resources

04/07 P6A Leave Sharing Donor Form (PDF) New Leave sharing donor form.

Leave

04/07 P12B Change of Name, Address or Social Security Number (SSN) (PDF) New Form used by employees to change name, address or SSN.

Employee Administration

04/07 P14A Part Time Temporary Faculty Appointment Authorization For Payment (PDF) New Provides wage compensation for part-time temporary faculty-level services in instruction, research, outreach or administration.

Employee Administration

04/07 P99 Request for Human Resources Records (PDF) New Request form to review or receive copies of official personnel records from Human Resources.

Employee Administration

04/07 P108 Emergency Hire Extension (PDF) New Emergency hire form for non-student wage employment.

Employee Administration

04/08 P120 Personnel Signature Authorization (PDF) New Human Resources Signature Authorization from the Dean or Vice President of a specified department.

Employee Administration

04/08 P153 Request to Establish Employee Award or Recognition Program (PDF) New Request for to establish employee award or recognition programs. Brief description, participating departments, and funding source.

Compensation

04/08 P154 Employee Recognition Award Payment and Leave Form (PDF) New Employee Recognition Aware Payment and Leave Form (Prior program approval required)

Compensation

04/08 N/A Return To Work Release (PDF) New Return to work release form based on evaluation. This form must be completed by the employee's treating physician.

Leave

04/21 N/A Shelter Leave / One Time Deferral 403(b) (PDF) New Sheltered leave/additional pay defferal form to modify salary as indicated.

Retirement

04/21 SS Summer Session Teaching Appointments (PDF) New This form is used for summer session 1 and 2 teaching appointments.

Employee Administration

04/08 N/A Summer Sessions Research Appointments (PDF) New Form used for the summer session research appointments only.

Employee Administration

04/08 N/A Volunteer Sample Letter (DOC) New Volunteer services sample letter including summary of duties and responsibilities. This form will download as an editable Word document.

Policy and Compliance

03/27 N/A Paid Parental Leave Eligibility (PDF) New Paid Parental Leave Eligibility Application Form

Leave

04/08 N/A FMLA Employee Packet-Certification of Health Care for Employee’s Serious Health Condition (PDF) New FMLA Employee Packet (PDF)

Leave

04/06 N/A FMLA Family Packet-Certification of Health Care for Family Member's Serious Health Condition (PDF) New FMLA Family Packet (PDF)

Leave

04/06 N/A Conviction Check Request (WEB) New Request conviction and other pre-employment checks.

Policy and Compliance

04/08 P6 Leave Sharing Recipient Form (PDF) New Leave sharing recipient form - reason for leave, estimated length of absence, and rights.

Leave

04/07 P14 Sample Letter for Part-Time Temporary Wage Appointment (P14) (DOC) New Sample letter for part-time temporary wage appointment (P14). Some information is instructional and you need to put in the appropriate information. This file will open as an editable Word document.

Employee Administration

04/06 A10385 State Active Enrollment (PDF) State health benefits program enrollment form for employees. This link will take user to the Department of Human Resource Management's website.

Benefits

03/17/26 F52833 Securian Enrollment Form (PDF) Enrollment application for VRS optional group life insurance with Securian Financial. This link will take the user to the Securian site.

Benefits

03/16/26 F53411 Securian Change Form (PDF) Change form for VRS optional group life insurance with Securian Financial. This link will take the user to the Securian site.

Benefits

03/16/26 F52749 Securian Evidence of Insurability (PDF) Evidence of insurability form for VRS optional group life insurance with Securian Financial. This link will take the user to the Securian site.

Benefits

03/16/26 P12W Wage Employee Appointment Record (PDF) New Wage employee appointment record form.

Employee Administration

04/07 P36 Request for Additional/Outside Employment for Classified or University Staff (PDF) New This form should be used by classified and university staff members to seek advance approval for additional employment outside of Virginia Tech in accordance with Policy 4070.

Employee Administration

04/07 P126 Memorandum of Agreement for Educational Aid Reimbursement (PDF) New This memorandum of agreement needs to be completed per Policy 4800, Tuition Benefits Program for Salaried Employees

Benefits

04/08 N/A Tuition waiver requests (WEB) New Online form used to create tuition waiver requests

Benefits

04/08 N/A Recruitment Consultation Request (WEB) New Complete this form to start recruitment initiation with the HR Recruitment team. Please enter information as thoroughly as possible.

Recruiting

04/08 N/A Orientation Scheduler (WEB) New Form for self-scheduling an orientation session

Orientation

04/08 VRS65 Faculty Optional Retirement Plan Election Form (PDF) New Complete this form if you are a faculty member enrolling in the Optional Retirement Plan (ORP)

Benefits

04/21 N/A Election to Change Optional Retirement Plan Provider (PDF) New Change Retirement Plan Provider

Benefits

04/07 N/A Prior Leave Accrual Transfer (PDF) New Prior Leave Accrual Transfer form

Leave

04/08 N/A HR Representatives (WEB) New HR representatives for senior management areas.

Strategic Initiatives

04/08 N/A Supervisor Bulk ePAF Update Bulk supervisor update form

Employee Administration

11/06/23 P89 Memorandum of Agreement - Bonus (DOC) New Promissory note to be completed when recruitment or retention bonus is offered. This file will open as an editable Word document.

Policy and Compliance

04/06 P146 Request for Extension of Probationary Period (DOC) Form to request probationary extension for staff within first year. This form will download as an editable Word document.

Staff Performance

03/26/26 N/A State Health Benefits Program Enrollment Form For Retirees, Survivors and LTD (PDF) Form that retirees, survivors, and LTD participants would fill out for state health benefits. This link will take user to the Department of Human Resource Management website.

Benefits

03/17/26 N/A Reappointment Letter Template-Research Faculty (DOC) Use this letter template for Research Faculty reappointments. This file will open as an editable Word document.

Recruitment

03/16/26 N/A Reappointment Letter Template-T&R and A/P Faculty (DOC) Use this letter template for Teaching and Research and Administrative and Professional Faculty reappointments. This file will open as an editable Word document.

Recruitment

03/16/26 N/A Zurich AD&D Beneficiary (PDF) New Complete your Zurich AD&D Beneficiary Designation

Benefits

04/21 N/A Zurich AD&D Enrollment (PDF) New Complete your Zurich AD&D Enrollment

Benefits

04/06 N/A Panel of Physicians - Blacksburg/Roanoke (DOC) New For Workers' Compensation, reference this form for the Panel of Physicians in the Blacksburg and Roanoke areas. The employee must sign this form. This form will open as a Word document.

Benefits

04/02 N/A Panel of Physicians - D.C. Area (DOC) New For Workers' Compensation, reference this form for the Panel of Physicians in the Greater Washington, D.C. area. The employee must sign this form. This form will open as a Word document.

Benefits

04/02 21131 New York Life Beneficiary Change Form (PDF) New Use this form to update beneficiary information with New York Life. This link will take you to a fillable PDF form on New York Life's website.

Benefits

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