Department of Human Resources
Forms & Documents Center
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Forms for: Adoption Assistance Benefits Information Continuing Education/Training Dental Insurance Insurance Employee Assistance Employee Orientation Employee Discipline Employment Flexible Spending Accounts (FSAs) Health Insurance Non-FMLA Leave of Absence Performance Management Pharmacy Retirement/Pension Plans Short Term Disability Tuition Assistance Transportation Vision Insurance Workforce Management  Adobe Acrobat Reader is freeware required to view PDF material. |
Our goal is to provide Human Resources forms electronically to reduce print costs and make the forms easily accessible to the Jefferson Community. If you don't see the form you need listed here, contact the Human Resources Department and they will send you the form you need.
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If you encounter trouble saving a form, right click the form link and choose "Save Target As" or "Save Link As". This will allow you to save the file locally on your computer for editing/printing.
Adoption Assistance
Benefits Information
Jefferson University Physicians STD SPD (NEW)
Thomas Jefferson University STD SPD (NEW)
Thomas Jefferson University Hospitals STD SPD (NEW)
Continuing Education/Training
Dental Insurance
Delta Dental Claim Form
Delta Dental SPD
Aetna Dental SPD (SPD coming soon)
Employee Assistance
Employee Discipline
Progressive Discipline Step Back Form
Employee Disciplinary Action Form
Poor Work Performance
TJUH Improper Behaviors
TJU/JUP Improper Behaviors
Probation Extension
Probationary Release
Employee Orientation
Services & Resources
Commuter Services
Fast Pass
Parent Resourcesfor Employees
Bright Horizons Daycare (PDF)
Service Provider Contact List (PDF)
Women's Health Source(PDF)
Carebridge
FirstCall
Activities Office
Jeff IBC Wellness CenterSecurity & Safety
Patient Safety Goals (PDF)
Environmental Health and Safety (PDF)
Jefferson Security Center City (PDF)
Methodist Security Handout (PDF)Information You Should Know
HIPAA Impact – Handling Inquiries with Confidentiality (PDF)
Patient Satisfaction Survey (PDF)
New Employee Orientation Schedule (PDF)
TJUH JeffSMART Departmental Onboarding ChecklistFinancial & Personal
Employee Self-Service (PDF)
Pay Schedule (PDF)
TIAA-CREF & Vanguard Individual Counseling Sessions (PDF)
Freedom Credit Union
Employment
TJU/JUP Employee Handbook
TJUH Employee Handbook
Probation
Surviving Change
Sexual Harassment
Jeff Temp Request Form for JUP
Jeff Temp Request Form
FLSA Overtime Presentation
TJU/JUP PAR Justification Form
PAR — for Departments requiring PARs, please contact Jeff Graphics at http://www.jeffgraphics.com or (215) 503-7450 to place an order.
Flexible Spending Account (FSA)
2012 Medical Spending Account Claim Form
2012 Dependent Care Spending Account Claim Form
Health Insurance
Personal Choice Out-of-Network Claim Form
Personal Choice PPO (SPD coming soon)
Keystone HMO (SPD coming soon)
Independence Blue Cross Consumer Driven Health Plan (CDHP) (SPD coming soon)
Non-FMLA Leave of Absence
Performance Management
TJU/JUP Performance Appraisal
TJU/JUP Manager Performance Appraisal
TJU/JUP Postdoctoral Fellow Performance Appraisal Form
TJU-JUP Job Description Template
TJUH JeffSMART Departmental Onboarding Checklist
Pharmacy
Retirement/Pension Plans
Jefferson University Physicians
Jefferson University Physicians Retirement Plan Summary Annual Report << NEW 06/15/2012
Jefferson University Physicians Retirement Plan Summary Plan Description
Jefferson University Physicians Retirement Plan Determination Notice
Jefferson University Physicians Voluntary 403(b) TDA Plan Summary Annual ReportThomas Jefferson University
Thomas Jefferson University Employees' Pension Plan Annual Funding Notice
Thomas Jefferson University Employees’ Pension Plan 5500 Annual Return/
Report of Employee Benefit Plan
Thomas Jefferson University Employees' Pension Plan Summary Plan Description
Thomas Jefferson University Retirement Plan for Faculty and Senior Administrative
Staff Summary Annual Report << NEW 06/15/2012
Thomas Jefferson University Retirement Plan for Faculty and Senior Administrative
Staff Summary Plan Description
Thomas Jefferson University Voluntary 403(b) TDA Plan Summary Annual ReportThomas Jefferson University Hospitals, Inc.
Thomas Jefferson University Hospitals, Inc. Employees’ Pension Plan Annual Funding Notice
Thomas Jefferson University Hospitals, Inc. Employees’ Pension Plan 5500 Annual Report/
Return of Employee Benefit Plan
Thomas Jefferson University Hospitals, Inc. Employees’ Pension Plan Determination Notice
Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan (Defined Benefit)
Summary Plan Description
Thomas Jefferson University Hospitals, Inc. Employees' Defined Contribution Pension Plan (DC)
Summary Plan Description
Thomas Jefferson University Hospitals, Inc. Retirement Plan For Senior Administrative
Staff Summary Plan Description
Thomas Jefferson University Hospitals, Inc. Employees’ Pension Plan Determination Notice
Thomas Jefferson University Hospitals, Inc. Voluntary 403b TDA Plan
Summary Annual Report
Thomas Jefferson University Hospitals, Inc. Defined Contribution Pension Plan
Summary Annual Report
Thomas Jefferson University Hospitals, Inc. Retirement Plan for Senior Administrator Staff
Summary Annual ReportAdditional Information
Retiree Checklist
Short Term Disability Insurance
Jefferson University Physicians STD SPD (NEW)
Thomas Jefferson University STD SPD (NEW)
Thomas Jefferson University Hospitals STD SPD (NEW)
Tuition Assistance
Jefferson Faculty/Senior Administrator Dependent Scholarship Application FY 12
Jefferson Faculty/Senior Administrator Dependent Scholarship Program FY 12
Jefferson Faculty/Senior Administrator Dependent Scholarship Application FY 13
Jefferson Faculty/Senior Administrator Dependent Scholarship Program FY 13
Jefferson Tuition Assistance Application
Transportation
Pretax Parking & Transportation Brochure
PATCO Contract Information
