University of Houston-Victoria

Human Resources

Forms

Affidavit for Wellness Leave

Employees are eligible to receive eight (8) hours of Wellness Leave that can be earned every 12 months.  This leave may be taken in increments of no less than 4 hours and must be taken within 12 months of earning the leave. To qualify for the Wellness Leave incentive, an eligible employee must complete an approved online Health Risk Assessment (HRA), receive an annual comprehensive physical exam AND submit the Physician’s Certification for Wellness Leave signed by a licensed healthcare provider indicating that a physical examination has been completed. Visit the BCBS Health Assessment flier for complete instructions on how to access the assessment.

Once you complete the assessment, take a screenshot of the confirmation page (no personal details), complete your section on the Affidavit for Wellness Leave, then have your physician and supervisor complete their portion. Once the form is complete, return the form and confirmation of online health assessment to Human Resources for processing.

Alternative Work Request
Used by employees to request work "flex hours" instead of normal work hours.

College Release Program
Used by employees to request release time to attend college courses.

Direct Deposit Authorization Form

Employee's Self Appraisal Form (Form A)

Feedback and Solutions Box
Intended to provide employees an opportunity to offer feedback and solutions

Identification Badge Request Form
Used to request a new or a replacement ID Badget/Proximity Card.

Job Performance Appraisal Form (Form B)

JAQ Form

JAQ Action Verbs

Job Reclassification Transmittal Form

New Employee Checklist

New Employee Reference List

HR PeopleSoft Security Form

Staff Fitness Release Time Application
Used to apply for the UHV Fitness Release Program

Formal Complaint Questionnaire