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Forms - Academic Staff

Submitted by ipthomps on Wed, 09/12/2012 - 1:41pm

Submitted by 21232f297a57a5a... on Tue, 07/01/2014 - 1:24pm

The following forms provided are for use by Academic Staff. For further information relating to these forms please contact Human Resources.

Note: Electronic forms must be saved to your desktop prior to editing and then sent to the designated area.

Employee Forms

Confidentiality Agreement

Form Description
Employee Confidentiality Agreement An agreement to uphold confidentiality of HR data for any employee whom accesses HR records as a function of the duties of their job. The agreement should be signed by anyone with access to confidential HR data and information.

Benefits and Pensions

Form Description
Alberta Blue Cross

Health Services Claim
Health Spending Account Claim
Travel Claim

Health & Dental Benefits Changes – please submit to Human Resources for processing

Links directly to the Alberta Blue Cross website. Staff can print the most commonly used claim forms for reimbursement of health and dental care expenses.

Alberta Health Care Insurance

AHC0102 – Application for Alberta Health Care Insurance Plan Coverage

AHC0199 – Employee Group Commencement and Termination for Alberta Health Care Insurance Coverage

Links directly to the Alberta Health and Wellness website where staff can access information as well as forms to apply for Alberta Health Care, add and/or delete dependents, register a change of address etc.
Wellness Spending Account Claim Form All Wellness Spending Account claims are made using this form. The claim form outlines allowable expenses as well as any exclusions.
Benefits and Pension Information and Forms Web page containing Benefits and Pension information and forms.

Leave of Absence (excluding R&S leaves)

Form Description
Application for Parental Leave  
Approval for Absence From Campus For leaves of short duration
Application for Special Leave For leaves with or without pay, some requiring the Provost's approval.
Application for Secondment  

Career Process Forms (including R&S leaves)

Form Description
Research and Scholarship Leave Application
and Notes
This form is to be filled out by the staff member to apply for a Research & Scholarship Leave or Administrative Leave
Graduate Supervision During Leave Proposed arrangements for graduate student supervision while on leave
Contract Research During Leave Form used to make arrangements for contractual research obligations while on leave
Re-Allocation of Space During Leave Form used to re-allocate office/research space during research & scholarship or administrative leave
R&SL Report Form This form is to be filled out and submitted with your report. This is to be signed by your department head (if applicable) and dean
R&SL Grant Application and Notes Form to be used by the staff member to apply to receive a portion of the R&SL assistance in the form of a Research & Scholarship Leave grant
Application for Approval of Employment for Compensation Application for approval of employment (overload) compensation while on R&SL
Proposal for Administrative Leave Proposal for administrative leave - Deans and Senior Administrators (SLT appoinments)
Salary Anomalies
Staff Application for Salary Adjustment Salary Anomalies/Staff Application for Salary Adjustment form

Personal Information

Form Description
Request for Employment Verification Letter Used to request a confirmation of employment letter for the purpose of confirming appointment type and compensation.
Academic Staff Personal Information Form Must be completed along with an AE1/AE2 for all NEW academic (AE1) and Adjunct/Clinical (AE2) hires. This will ensure that the proper data is entered on our system.
Academic Staff Personal Information Form Cumming School of Medicine To be used for the Cumming School of Medicine.
Employment Equity Survey This form can also be found at https://www.ucalgary.ca/hrsecure/ and filled in on-line.

Payroll Deadline Calendars and Tax Forms

Direct Deposit Information JobAid Your direct deposit information is now available through Employee Self Service. The job aid found here will take you step-by-step through the process. Log-in to the MY U OF C portal, then go to My Records - Employment Records - Employee Self Service, and follow the job aid instructions from there.

Tuition Support / PER

Form Description

Academic Courses

Tuition Support Program Registration for Academic Courses

Continuing Education Courses

Tuition Fee Remission Application for Continuing Education Courses

Form used when a staff member or eligible dependent is registering in academic and Cont Ed courses offered through the University of Calgary  programs.

The Academic Tuition Support form will not be available after the fee deadline.

Professional Expense Reimbursement (PER) Handbook  

Submitted by 21232f297a57a5a... on Tue, 07/01/2014 - 1:51pm

Administrator Forms

Appointments - Appointment Package

Form Description
Academic Appointment AE1 Form: Used to recommend an appointment (or reappointment) of Academic Staff to continuing (Initial Term and with Tenure), contingent, and limited term appointments

Adjunct/Clinical Hire Form

Adjunct/Clinical Hire Form (Medicine)

Adjunct/Clinical Hire Form (Nursing)

AE2 Form: Used to recommend an appointment or reappoinment of Adjunct, Clinical, or Instructor appointments
Recommendation for Administrative Appointment (Honorarium) AE4H Form: Used to recommend an administrative appointment or reappointment. These include appointments as Department Heads, Assistant and Associate Deans, Area Chairs, Program Directors, Assistant and Associate Directors etc.
Administrative Appointment (Research Award)

AE4R Form: Recommendation for an active academic staff member to be appointed to an administrative role that will be paid by a research award.

Academic Staff Personal Information Form

Academic Staff Personal Information Form FAC MED

 
Reporting Requirements for Employment Equity Purposes To be used for each academic selection process
Market Supplement Request Form Used to request the Provost's approval on a market supplement
Academic Appointment (Non Canadian Sessional) AE5 Form: Used for Academic Appointments (Non-Canadian Sessionals, Retired Short-term and Faculty Professor Appointments)

Appointments - Changes to Existing Appointments

Form Description
Approval of Overload Duties Used when an active faculty member is assigned overload duties in addition to their normal workload
Administrative Appointment (Honorarium)

AE4H Form: Recommendation for an active academic staff member to be appointed to an administrative role that will be paid by honorarium. These include appointments as Department Heads, Assistant and Associate Deans, Area Chairs, Program Directors, Assistant and Associate Directors etc.

Administrative Appointment (Research Award)

AE4R Form: Recommendation for an active academic staff member to be appointed to an administrative role that will be paid by a research award.

Market Supplement Status Form Used to request a decrease/increase/renewal/expriration of an existing market supplement.
Provost Adjustment Fund Request Form  
Provost Fund Procedures  

Appointments - Immigration

Form Description
Labour Market Impact Assessment Application (LMIA) Application form for a Labour Market Impact Assessment (LMIA) for occupations requiring post secondary education/training (management, scientific, professional, and technical occupations and trades.
Guide for Completion of LMIA  
Foreign Academic Recruitment Summary  
Guide for Completion of Summary  
International ID Request Form This form is intended to request an ID number for international Adjunct/Clinical and Visiting Scholars whose appointment is pending receipt of work permit and SIN information.

Appointments - Onboarding

Form Description
Employee Confidentiality Agreement An agreement to uphold confidentiality of HR data for any employee whom accesses HR records as a function of the duties of their job. The agreement should be signed by anyone with access to confidential HR data and information.
Employment Equity Survey This form can also be found at https://www.ucalgary.ca/hrsecure/ and filled in
on-line.
Onboarding Checklists for New Hire, Hiring Manager, and Onboarding Coordinator Provides a comprehensive onboarding list of the steps for the New Staff Member, Hiring Manager, and the Onboarding Coordinator.

Appointments - Faculty Professor

Other

Form Description
One-Time Payment Form

Used for one time payments in addition to regular salary, such as lump sum and honorarium payments for academic employees.

Visit the Finance Services Payroll site to access the form.

Accounting Change Form  

Termination and Retirement

Life Events

Submitted by 21232f297a57a5a... on Wed, 06/25/2014 - 4:13pm

List of relevant forms:

Please click on the EVENT below for for information on Benefit Change Forms in the case of a "Life Change Event" such as Addition/Deletion of Dependent, Marriage/Separation/Divorce, Change of Beneficiary, Retirement etc.

Addition / Deletion of Dependent

Eligible dependents include unmarried, unemployed dependent children under the age of 21 or; if over the age of 21 but less than age 25, they must be attending an accredited educational institution, college or university on a full-time basis. Children of a common-law spouse may be covered if they are living with you.

Link to: Benefits Change Form

Once applicable forms are completed and signed, please forward to Human Resources for processing.(4th floor MacKimmie Tower)

Benefit Eligibility What do I do
Alberta Health Care Within 31 days of event Complete the applicable Notice of Change Form. It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.
Extended Health and Dental Within 31 days of event Complete Benefit Change Form to add or delete child.

* If change is not received by Human Resources within 31 days of event, then the change will be processed the first of the following pay period in which the change was received.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Over-Age Dependent Declaration

Unmarried dependent child between the ages of 21 and 25 in full-time attendance at an accredited educational institution, college or university.

Benefit Eligibility What do I do
Alberta Health Care When child turns 21 year of age and/or prior to September 1 each year Complete the applicable Notice of Change Form (only if student is not covered by you).

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental When child turns 21 year of age prior to September 1 each year Complete the Overage Dependent Declaration Form and forward to Human Resources, 4th floor MacKimmie Tower.
Optional Child Life Insurance (Over-age Dependent) When disabled child turns 21 year of age evidence of insurability is required to continue coverage under the plan. Contact totalrewards@ucalgary.ca to obtain Application for Over-Age Disabled Dependent Coverage form.

Cost of medical examination is the responsibility of the employee.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Marriage

Within 31 days of your date of marriage, please complete a Benefit Change Form. Completion of the form will facilitate the change of your name (if applicable), addition of your spouse to your health and dental plans, as well as designate your spouse as beneficiary for your Life Insurance and Pension plans.

NOTE: If the Benefits Change Form is received after the 31 day grace period, your spouse will be added to your Health and Dental Plans the first of the following pay period in which the forms are received.

Link to: Benefits Change Form

Once applicable forms are completed and signed, please forward to Human Resources for processing. (4th floor MacKimmie Tower)

Benefit Eligibility What do I do
Alberta Health Care Within 31 days of date of marriage Complete the applicable Alberta Health and Wellness Notice of Change Form.

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental Within 31 days of date of marriage Complete Benefit Change Form to have your spouse added your health & dental plans.
Life Insurance Within 31 days of date of marriage Complete Benefit Change Form to have your spouse named as beneficiary for both your Basic and Optional Life Insurance plans.
Accidental Death & Dismemberment Within 31 days of date of marriage Complete Benefit Change Form to have your spouse named as beneficiary for both your Basic and Optional AD & D.
Pension Plan Within 31 days of date of marriage Complete a Declaration of Spouse and Designation of Non-Spouse Beneficiary Form
Name Change Within 31 days of date of marriage Complete Benefit Change Form to change your name.
Change of Address Within 31 days of date of marriage Complete Benefit Change Form to change your address.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Domestic Partnership

For your Domestic Partner to be eligible for addition to your Health and Dental plans, you must have cohabited continuously for a minimum of 12 months. Completion of the Benefit Change Form will facilitate the addition of your Domestic Partner to your health and dental plans as well as provide you the opportunity to designate your Domestic Partner as beneficiary for your Life Insurance and Pension plans. Both you and your partner will be required to complete a Domestic Partner Declaration.

NOTE: If the Benefit Change Form is received after the 31 day grace period, your spouse will be added to your Health and Dental Plans the first of the following pay period in which the forms are received.

Link to: Benefits Change Form

Once applicable forms are completed and signed please forward to Human Resources for processing. (4th floor MacKimmie Tower)

Benefit Eligibility What do I do
Alberta Health Care First of the month following 3 years of cohabitation Complete  the applicable Alberta Health and Wellness Notice of Change Form.

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental 1 year from date of cohabitation Complete Benefit Change Form to have your partner added to your health and dental plans.
Life Insurance At staff member’s discretion Complete Benefit Change Form to have your partner named as beneficiary for both your Basic and Optional Life Insurance plans.
Accidental Death & Dismemberment At staff member’s discretion Complete Benefit Change Form to have your partner named as beneficiary for both your Basic and Optional AD & D.
Pension Plan Following 3 years cohabitation Complete a Declaration of Spouse and Designation of Non-Spouse Beneficiary Form.
Residence Change If required Complete Benefit Change Form to change your address.
Establishing the Partnership Mandatory Complete Domestic Partner Declaration Form. Forward to Human Resources. 4th floor, MacKimmie Tower.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Separation

At time of separation you may choose to remove your partner from your Health and Dental plans as well as re-designate your beneficiary for your Life Insurance plan. Your spouse can not be removed as beneficiary of your pension plan until your divorce is finalized.

Link to: Benefits Change Form

Once applicable forms are completed and signed please forward to Human Resources for processing. (4th floor MacKimmie Tower)

Benefit When What do I do
Alberta Health Care At plan holder’s discretion Complete the applicable Alberta Health & Wellness Notice of Change Form.

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental At staff member’s discretion Complete Benefit Change Form to delete spouse from health and dental plans.

There is no requirement to remove your spouse from the plans during the period of separation. Only at time of divorce must the ex-spouse be removed.

Life Insurance At staff member’s discretion Complete Benefit Change Form to re-designate your beneficiary for both your Basic and Optional Life Insurance plans.
Accidental Death & Dismemberment At staff member’s discretion Complete Benefit Change Form to re-designate your beneficiary for both your Basic and Optional Accidental Death & Dismemberment.
Pension Plan During separation or up to date of divorce Your spouse remains your beneficiary until your divorce is final.

A Matrimonial Property Order (MPO) or Consent Order is required by the plan administrator to split pension benefits upon marital breakdown. A draft order should be provided to Buck Consultants for review to ensure it complies with pension legislation and plan regulations. You, your spouse and legal representatives should contact Buck Consultants at: 1-866-709-2092 (toll-free).

Change of Address As required Complete Benefit Change Form to change your address.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Divorce

Once your divorce is finalized, your former spouse is no longer eligible for coverage under the University of Calgary’s Extended Health and Dental Plans.

Link to: Benefits Change Form

Once applicable forms are completed and signed please forward to Human Resources for processing. (4th floor MacKimmie Tower)

Benefit When What do I do
Alberta Health Care Once divorce is finalized Complete the applicable Alberta Health and Wellness Notice of Change Form.

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental Once divorce is finalized Complete the Benefit Change Form to have your former spouse removed from your health and dental plans.
Life Insurance At staff member’s discretion Complete Benefit Change Form to have your former spouse removed as beneficiary for both your Basic and Optional Life Insurance plans (provided there is no requirement for them to remain a beneficiary).
Accidental Death & Dismemberment At staff member’s discretion Complete Benefit Change Form to have your former spouse removed as beneficiary for both your Basic and Optional AD & D (provided there is no requirement for them to remain a beneficiary).
Pension Plan After divorce is finalized Complete a Declaration of Spouse and Designation of Non-Spouse Beneficiary Form and provide a certified true copy of the front page of your Divorce Decree.

Ensure that the final Matrimonial Property Order or Consent Order, signed by the Court is sent directly to Buck Consultants:

155 Wellington Street West
Suite 3000
Toronto, Ontario M5V 3H1
1-866-709-2092 (toll free)

Name Change As required Complete the Benefit Change Form to change your name.
Change of Address As required Complete Benefit Change Form to change your address.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Change of Beneficiary

You must complete a Benefits Change Form to change the named beneficiary for your Basic and/or Optional Life Insurance, and Accidental Death and Dismemberment Plans.

Complete a Declaration of Spouse and Designation of Non-Spouse Beneficiary Form to make changes to a named beneficiary for the Universities Academic Pension Plan.

Once completed return all applicable forms to Human Resources 4th floor MacKimmie Tower.

Death of Eligible Dependent and/or Beneficiary

We all face losses throughout our life. When the loss is the death of someone close to us, the grieving process can affect both our home and work life. The Staff Wellness Centre offers information and resources to help employees and their families during the time of a loss. For information and support please contact: Staff Wellness Centre.

Link to: Benefits Change Form

Benefit When What do I do
Alberta Health Care At earliest convenience Complete the applicable Alberta Health and Wellness Notice of Change Form.

It is the staff member’s responsibility to send the completed form directly to Alberta Health and Wellness.

Extended Health and Dental At earliest convenience Complete Benefit Change Form.
Life Insurance At earliest convenience Complete Benefit Change Form.
Accidental Death & Dismemberment At earliest convenience Complete Benefit Change Form.
Pension Plan At earliest convenience Complete a Declaration of Spouse and Designation of Non-Spouse Beneficiary Form for death of either a spouse or alternate beneficiary.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Approaching Age 65

Staff members age 65 and older, who continue to work in an eligible employment category, continue to participate in the University’s group benefit plans.

Coverage continues for Extended Health and Dental, Flexible Spending Account, Group Life Insurance and Accidental Death & Dismemberment for you and your eligible dependents. Please review the following, which outlines benefit changes and other important information.

Benefit Plan Changes / Information
Alberta Health and Wellness Alberta Health and Wellness will contact you 6 months prior to your 65th birthday regarding application for Alberta Blue Cross Senior’s Benefits.
Extended Health and Dental The Alberta Blue Cross (ABC) Senior’s Plan will become first payer when having prescriptions filled. You will be required to present both the ABC Senior’s card and ABC University group ID card when you or your eligible family members access services from the pharmacy and/or dentist.
Canada Pension Plan (CPP)

You have the option of applying for benefits to commence any time after age 60. Applications for CPP should be made 6 months prior to the date of commencement. For more information and application forms, refer to the CPP website http://www.servicecanada.gc.ca/eng/services/pensions/cpp/retirement/index.shtml.

If you elect to commence receipt of CPP benefits, it is important that you provide the Payroll Office with a copy of the confirmation letter received from the Canada Pension Plan.

If you continue working while receiving CPP pension:

  • age 60 to 65: CPP contributions are mandatory and additional CPP pension accrues
  • age 65 to 70: CPP contributions continue and additional CPP pension accrues unless file a form with the Canada Revenue Agency (provide a copy to the University's Payroll Services) found on CPP website http://www.servicecanada.gc.ca/eng/services/pensions/cpp/prb/index.shtml
  • Over age 70: CPP contributions stop and no additional CPP pension accrues
Old Age Security (OAS) You are entitled to receive Old Age Security in addition to CPP at age 65 regardless of whether or not employment continues. OAS can be delayed for up to 5 years in exchange for an increased amount. For information and application forms, refer to the OAS website http://www.servicecanada.gc.ca/eng/services/pensions/oas/pension/index.shtml.
Optional Life Insurance Coverage ceases when the staff member or spouse, as applicable, reaches age 75 or retirement, whichever is earlier.
Long Term Disability Insurance Coverage ceases at the earlier of: (1) retirement or (2) June 30 coincident or following
the date which is six months prior to 65th birthday.
Pension Plan You are not required to retire at age 65. However, once you have elected a retirement date, a letter of resignation should be submitted to the President, via your department Head and Dean. Written notification of your election to retire should be provided approximately 4 months prior to an elected retirement date.

For more information regarding retirement: Preparing for Retirement - Academic Staff.

For more information on Life Events, or the completion of any of these forms, call the Integrated Service Centre at 220-5932 to speak to an agent.

Pension Estimates/Retirement

Staff considering retirement can obtain pension estimates by accessing the retirement planner available on the UAPP website at www.uapp.ca. The following summary shows how to access the UAPP retirement planner: How to Access UAPP Statements and Retirement Planner.

Staff members age 55 or older and have 2 or more years of pensionable service are eligible for an immediate pension from the Universities Academic Pension Plan.

Once a staff member has elected to retire, written notification to the President via your department and dean, should be provided 4 months prior to the chosen retirement date. A retirement options package for the Universities Academic Pension Plan will be provided to members approximately 1 to 2 months prior to an elected retirement date. More information regarding preparing for retirement and retirement process:

Preparing for Retirement – Academic Staff

Retirement Checklist – Academic Staff

At retirement, group benefits coverage ceases. There are a number of benefits and privileges available to retired staff. Further details can be found on the following link:

Information for Retiring Academic Staff

Benefits and Pension at Termination of Employment

Benefit Coverage Ceases/Additional Information
Extended Health and Dental On date of termination.

Alberta Blue Cross provides non-group health and dental coverage. For more information:

Alberta Blue Cross

Group Life Insurance Basic and Optional Life Insurance – Conversion Privilege

Upon receipt of an employee's request to resign or retire from the University of Calgary, the Life Insurance group coverage will expire thirty-one (31) days after the effective date of termination. Within thirty-one (31) days of termination of the University group coverage, a Conversion Privilege (for both Basic and Optional coverage) is available to convert an employee to an individual policy without medical evidence of insurability. The Life Insurance rates are provided in the Manulife Group Insurance - Application for Conversion form.

In order to apply for the Conversion Privilege, please complete sections 2 and 3 of the Manulife Group Insurance - Application for Conversion and send your completed form to:

Human Resources
Attn: Benefits and Pension Team
MacKimmie Tower, 4th Floor

The Benefits and Pension team will complete section 1 and return the form to the employee via Canada Post to the employee's current home address on file. Please ensure your mailing address is up to date and accurate.

Please contact Manulife Financial (1-888-626-8543) directly for any questions regarding the available conversion options or on how to apply for the conversion.

NOTE: If you are over age 65, please contact Manulife for applicable rates.

Child Optional Life Insurance On date of termination.
Accidental Death & Dismemberment Accidental Death and Dismemberment (AD&D) – Conversion Privilege

Upon receipt of an employee's request to resign or retire from the University of Calgary, the Accidental Death and Dismemberment coverage will expire thirty-one (31) days after the effective date of termination. Within thirty-one (31) days of termination of the University group coverage, a Conversion Privilege (for both Basic and Optional coverage) is available.

In order to apply for the Conversion Privilege, please complete Part II of the Group Accident Insurance Conversion Notice and send completed form to:

Human Resources
Attn: Benefits and Pension Team
MacKimmie Library Tower, 4th Floor

The Benefits and Pension team will complete Part I and return the form to the employee via Canada Post to the employee's current home address on file. Please ensure your mailing address is up to date and accurate.

Please contact SSQ Financial Group directly for any questions regarding the application for the conversion.

Long Term Disability On date of termination.
Universities Academic Pension Plan (UAPP) Purchase of eligible previous or leave service would need to be completed within 30 days of termination. Contact an HR Pension Advisor immediately at (403) 220-5461 for information and related deadlines. Purchase of eligible service immediately prior to termination will delay production of termination options package.

Within 6 to 8 weeks after the last day of employment, Buck Consultants will provide an options package directly to the member. Please ensure your current address is provided on PeopleSoft.”

Flexible Spending Account On the date of termination.

Claims for eligible expenses must be submitted to Alberta Blue Cross within 90 days of termination. Receipts must be dated prior to date of termination.