Human Resources and Payroll

Benefits

 

 

Benefits Forms

New to Mason?

Welcome!  This benefits summary may come in handy when making decisions on your Mason benefits package.  Please don't hesitate to call HR & Payroll at 703-993-2600 and ask for the Benefits Team if you have any questions.

Health and Flexible Benefits Forms (DHRM Web Site)

Retirement Related Forms

Retirement and Life Insurance Forms (VRS)
Faculty Retirement Transition Leave Program: Election Form
Faculty Retirement Transition Leave Program: General Release and Covenant Not to Sue form

GMU 403(b) Salary Reduction Agreement (2017)

Tax-Sheltered Annuity Plan Acknowledgement and Opt-Out Form

Tax-Sheltered Annuity Plan Notice of Automatic Enrollment

One-Time Deferral Form

Family and Medical Leave Act (FMLA) Forms

FMLA Leave Request Form
FMLA Leave Supplement Form
FMLA Certification Form
FMLA Designation Form
Extended Leave Request (Supervisor Notification)
Return to Work Form
Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave
Certification of Qualifying Exigency for Military Family Leave

Virginia Sickness and Disability Program (VSDP) Forms

Extended Absence Leave Supplement Form
Extended Leave Request (Supervisor Notification)
VSDP Short Term Disability Return to Work

Workers' Compensation Protocol

Workers' Compensation Return to Work Form
Transitional Duty Plan Form
Panel Physician Selection Form (Virginia)-initial visit

Panel Physician Selection Form (Maryland) -initial visit

Panel Physician Selection Form- Biomedical Research Lab Only

Panel Physician Selection Form- Front Royal

Panel Physician Selection Form- Orthopedic
First Report of Accident Form
VA DMV Disabled Parking Application - pdf (23Kb)
VSDP Handbook - pdf (196Kb)

 

Other

eDirect Overview

eDirect

 

Can't find what you're looking for?

Visit our Forms page for a comprehensive list of HR & Payroll forms.