Human Resources
Human Resources
Main 25
700 College Drive
Decorah, Iowa 52101
Phone: 563-387-1134
Fax: 563-387-1391
Forms
Payroll and Tax Forms
- Form I-9: Employment Eligibility Verification
- Form W-4: Federal Income Tax Withholding
- Form W-4: Iowa Income Tax Withholding
- Direct Deposit Form for faculty and staff
- W-2 Options
- W2 Notice/Instructions for Employee
Additional Employment Forms
- Volunteer Agreement Form
- Temporary Employee Offer Worksheet
- Request to Hire Form (Word doc)
- Job Description Template
- Remote Work (Regular) Form
- Remote Work (Ad Hoc) Form
- Employee Chosen Name Application
- Minors on Campus Training Workbook
- Workers Compensation Reporting Worksheet
Employee Benefit Forms
- TIAA Retirement Plan Salary Deferral Agreement
- TIAA Rollover Form (to roll monies into your Luther retirement account)
- UMR Health Insurance Enrollment & Change Form
- UMR Health Insurance Claim Submission Form
- Express Scripts Prescription Drug Claim Submission Form
- 2022 Wellness Checkup Form
- Optum Bank Health Savings Account (HSA) Authorization Form
- Optum Bank Health Savings Account (HSA) Authorization Form
- Flexible Spending Account Enrollment & Change Form
- Flexible Spending Account Health Care Reimbursement Form
- Flexible Spending Account Dependent Care Reimbursement Form
- Delta Dental Insurance Enrollment & Change Form
- Staff Parental Leave Request Form
- Faculty Parental Leave Request Form
- Moving Expense Form for New Employees
- 2022-23 Part-Time Tuition Credit Application (faculty/staff taking a class)
Human Resources
Human Resources
Main 25
700 College Drive
Decorah, Iowa 52101
Phone: 563-387-1134
Fax: 563-387-1391