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Deaf or Hard of Hearing? Duke Human Resources
705 Broad St. Box 90496
Durham, NC 27705
Phone: (919) 684-5600
Para informacion en espanol?

Forms

Most Requested Forms

Benefits Forms

Medical Benefits
Medical Care Enrollment Form (new hires)
Medical Care Enrollment Form (qualifying life events)
Medical Claim Form - Coventry Health Care
Medical Claim Form - BlueCross BlueShield
International Claim Form - BlueCross BlueShield
Dental Benefits
Dental Care Enrollment Form (new hires)
Dental Care Enrollment Form (qualifying life events)
Dental Claim Form - Ameritas
Vision Benefits
Vision Care Enrollment Form (new hires)
Vision Care Enrollment Form (qualifying life events)
Vision Plan Claim Form (for out-of-network providers)
Pharmacy Benefits
Express Scripts Mail Order Form
Mental Health and Substance Abuse Benefits
CIGNA Out-of-Network Claim Form
Disability
Hartford Personal Health Statement
Voluntary Disability Enrollment Form
Hartford Voluntary LTD Conversion Form
Request a Duke Disability Claim Kit
Educational Benefits
Employee Tuition Assistance Program Application
Children's Tuition Grant Program Application
Health and Wellness Forms
Placement Health Review
Health Review for Animal Handlers
Tuberculosis Questionnaire
Tuberculosis Screening Documentation
Travel Questionnaire
Flu Shot Exemption Forms
Life Insurance
Basic Life Insurance Beneficiary Designation Form
Personal Accident Insurance Enrollment/Beneficiary Form
Supplemental Life Insurance Enrollment Form
Supplemental Life Insurance Beneficiary Designation Form
Reimbursement Accounts
Reimbursement Accounts Enrollment/Change Form
Health Care Reimbursement Account Claim Form
Dependent Care Reimbursement Account Claim Form
Retirement
Retirement Plan Contribution Form – Pre-tax Deductions
Retirement Plan Contribution Form – Roth After-tax Contributions
Request for Benefits Estimate - Employees' Retirement Plan
Fidelity Enrollment Application
TIAA-CREF Enrollment Application
VALIC Retirement Enrollment Application
Vanguard Enrollment Application
Same Sex Spousal Equivalency
Declaration of Same-Sex Spousal Equivalent Relationship
Same-Sex Spousal Equivalent Certification of Dependent Status
Affidavit Terminating a Same-Sex Spousal Equivalent Relationship
Work Absences
Leave of Absence Request Form (Form 1001)
Payroll Leave of Absence Form
Certification of Health Care Provider for Employee's Serious Health Condition (Form 1002)
Certification of Health Care Provider for Family Member's Serious Health Condition (Form 1002)
Certification for Serious Injury or Illness of Covered Servicemember
Certification of Qualifying Exigency for Military Family Leave
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
Designation Notice (Family and Medical Leave Act) (Form 95)
Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act) (Form 1003)
Kiel Program Application Form
Kiel Program Donor Form
Kiel Payment Form
Paid Parental Leave Request: Primary Caregiver Affidavit

Data Request Forms

Request for Duke Personnel Data
Request for Duke Personnel Data Form
Voluntary Self-Identification of Veteran Status
New Employee Self-Identification Form (sex, race and ethnicity)

International Employee Forms

International Employee Forms
Education Allowance Long Term International Program Application

Jobs Forms

Resumes/Applications
Duke Jobs web site (external candidates)
Duke Jobs web site (Duke employees)
Duke Jobs web site (nursing candidates)
Hire/Termination
Confidentiality Agreement
Foreign National Form
Student Payroll Form
Supplemental Pay Form
Telephone Reference Check
Tax
NC-4 - Employee's Withholding Allowance Form
W-4 - Employee's Withholding Allowance Form

Worker's Compensation Forms

Worker's Compensation
Report of Work-Related Accident, Injury, or Illness