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!

Employee Information

Employee Name

First MI Last

Preferred First Name

Birth Date(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Phone Number

Position Information

Employment Start Date(Required)

Position Title(Required)

Department

Campus Work Location(Required)

Salary

Are you a 9 Month Faculty?(Required)

Yes

Number of Pays (if less than 12 month employee)

Session Enrollment Selection

Date of Hire Selection

The last hire date of the year is 12/4/2023. The first date of hire for 2024 is 1/2/2024.

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

Name of Person Completing Request(Required)

First Last

Employee Information

Position Information

Session Enrollment Selection

Announcements & Events

Resources

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