Benefits Enrollment Session Request

Benefits-eligible arriving employees need to participate in the first benefits enrollment session after the date of hire. Sessions are designed to provide arriving employees with information about their benefits and to assist them in completing the necessary forms to enroll in benefit components. *These sessions are generally held from 9:30 a.m. until 12:00 p.m. on designated dates, and the location is Drinko Library Room 349 unless otherwise indicated. New employees will receive confirmation with their Benefits Packages.

Use this form to request a reservation for a benefits enrollment session for your newly hired employee. Simply fill in the fields below and/or make selections where dropdown lists are provided. When you are sure the information you have entered is correct, hit the Submit button.

If you experience any difficulty with this web form, you can accomplish your registration by contacting Human Resource Services either by telephone or by e-mail. Thank you!

Benefits Enrollment Session Request

Employee Name: *
Birth Date:
Preferred First Name:
Current telephone number (with area code):
Email *
Address:
City:
State:
Zip:
Department, college, or office:
Position title (faculty, Program Assistant, etc.):
Annual Salary:
9-month faculty:
Type:
18 or 24 Pays:
Employment Begins:
Date of Session: Note: Please make sure you select the first session after your date of hire. Faculty hired in August may attend any session held in August.

Campus work location:

Comments or Special Request related to benefits enrollment should be entered below:

Name and telephone number of person completing request:

Verification

Please enter any two digitsExample: 12
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