Thomas Jefferson University

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Forms & Documents Center

Our goal is to provide Human Resources forms electronically to reduce print costs and make the forms easily accessible to the Jefferson Community. If you don't see the form you need listed here, contact the Human Resources Department and they will send you the form you need.

Some of the form formats provided here requires Adobe Acrobat Reader or Microsoft Word. See the link below to acquire the plug-ins for your browser. This plug-in will allow you to view the PDF forms within your Internet Browser.

Instructions for Saving Forms:

If you encounter trouble saving a form, right click the form link and choose "Save Target As" or "Save Link As". This will allow you to save the file locally on your computer for editing/printing.

Adoption Assistance

Benefits Information

Continuing Education/Training

Dental Insurance

Delta Dental Claim Form
Delta Dental SPD
Aetna Dental SPD (SPD coming soon)

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Employee Assistance

Employee Discipline

Employee Orientation

Employment

Flexible Spending Account (FSA)

Health Insurance

Personal Choice Out-of-Network Claim Form
Personal Choice PPO (SPD coming soon)
Keystone HMO (SPD coming soon)
Independence Blue Cross Consumer Driven Health Plan (CDHP) (SPD coming soon)
Prescription Insurance - Optum Rx Member Reimbursement Form

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Non-FMLA Leave of Absence

Performance Management

Retirement/Pension Plans

Jefferson University Physicians
Jefferson University Physicians Retirement Plan Summary Annual Report (PDF) << NEW 06/15/2012
Jefferson University Physicians Retirement Plan Summary Plan Description (PDF)
Jefferson University Physicians Retirement Plan Determination Notice (PDF)
Jefferson University Physicians Voluntary 403(b) TDA Plan Summary Annual Report (PDF)

Thomas Jefferson University
Thomas Jefferson University Employees' Pension Plan Annual Funding Notice (PDF)
Thomas Jefferson University Employees' Pension Plan 5500 Annual Return/
Report of Employee Benefit Plan (PDF)

Thomas Jefferson University Employees' Pension Plan Summary Plan Description (PDF)
Thomas Jefferson University Retirement Plan for Faculty and Senior Administrative
Staff Summary Annual Report (PDF)
<< NEW 06/15/2012
Thomas Jefferson University Retirement Plan for Faculty and Senior Administrative
Staff Summary Plan Description (PDF)

Thomas Jefferson University Voluntary 403(b) TDA Plan Summary Annual Report (PDF)

Thomas Jefferson University Hospitals, Inc.
Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan Annual Funding Notice (PDF)
Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan 5500 Annual Report/
Return of Employee Benefit Plan (PDF)

Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan Determination Notice (PDF)
Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan (Defined Benefit)
Summary Plan Description (PDF)

Thomas Jefferson University Hospitals, Inc. Employees' Defined Contribution Pension Plan (DC)
Summary Plan Description (PDF)

Thomas Jefferson University Hospitals, Inc. Retirement Plan For Senior Administrative
Staff Summary Plan Description (PDF)

Thomas Jefferson University Hospitals, Inc. Employees' Pension Plan Determination Notice (PDF)
Thomas Jefferson University Hospitals, Inc. Voluntary 403b TDA Plan
Summary Annual Report (PDF)

Thomas Jefferson University Hospitals, Inc. Defined Contribution Pension Plan
Summary Annual Report (PDF)


Additional Information
Retiree Checklist

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Short Term Disability Insurance

Tuition Assistance

Transportation

Vision Insurance

Workforce Management