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Category: Forms

Abusive Conduct Intake Form

To file a complaint of Abusive Conduct, a completed copy of this form must be sent to: Division of Human Resource Management Administrative Office, 4315 S 2700 W, Suite 2100, Salt Lake City, Utah 84184. FAX: 801-538-3081 Email: phone: 801-618-6720 Abusive Conduct Intake FormDownload

Express Scripts COB Form

Complete this form to submit a claim to for pharmacy purchases. Express Scripts COB and Reimbursement Form

Schedule A Agreement

Career Service Exempt Conversion Election Agreement & Acknowledgement Career Service Exempt Appointments  Schedule Exempt Conversion

Express Scripts by Mail

Complete this form to submit a prescription by mail to Express Scripts to the address listed on the claim form. Express Scripts by Mail form

Classification Position Analysis Form – PAF

All information on the Position Analysis Form (PAF)  should be completed by the incumbent and/or supervisor to reflect the tasks currently assigned to the position.  Please refer to the Classification Review Request (CRR-3) form to initiate a request for a preliminary classification review of an incumbent filled position(s). Position Analysis Form  Google Doc

Savings Plans Direct Deposit for One-time Payments

Use this form for a direct deposit of one-time payments from your Utah Retirement Systems (URS) Savings Plans (401(k), 457, and IRAs). Completed forms can be sent directly to URS at fax number 801-366-7445. URS Savings Plans Direct Deposit for One-time Payments

Uncompensated Overtime Claim Form for Non-Exempt Employees

This form is used by State of Utah employees who desire to make a claim to be compensated for overtime hours for which they were required or permitted to work, over the past three years up to today’s date, but for which they were not compensated due to the work hours not being recorded on their previously submitted time sheets or electronic records (ESS). Uncompensated Overtime Claim Form 2014

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Conflict of Interest Form

DHRM Rules R477-9-2 and R477-9-3 require that employment with the state be the principal vocation for full-time employees. A state employee may only engage in outside employment or receive honoraria or paid expenses for activities outside of state employment when the employment or activities do not: a. Interfere with the employee’s efficient job performance. b. Conflict with the interests of the agency or the State of Utah. c. Give reason for criticism or suspicion of conflicting interests or duties. An employee must notify agency management in writing if outside employment or paid ...

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