Forms For New Hires

Congratulations on becoming a new employee of Pace University!  Please submit below completed forms to your campus HR office listed below within 3 days of your start date. Your I.D. and systems access will only be effective once the forms are received and processed.

Westchester campus employees:
235 Elm Road, Dow Hall RM 105
Briarcliff Manor, NY 10510

 New York campus employees:
 156 William Street, 5th floor,
 New York, NY 10038

International Students are encouraged to call their campus HR office to schedule an appointment to review their new hire forms.

 

Employment Forms for New Hires

Personal Data Form (PDF) Complete to notify Human Resources of name, address, telephone, and other personal information.
Employment Eligibility Verification I-9 Form  (Fill in Pdf) Complete when filling out new hire paperwork. Documents requested on this form must be brought into our Human Resources Office. This form must be completed by the new employee on or before their first day of work.
Employers must complete Section 2 by examining evidence of identity and employment eligibility within three(3) business days of the date employment begins.
Authorization Agreement for Direct Deposit   (Word)  Complete to deposit your pay automatically. Required for staff & faculty. Students may have payroll deposited to onecard, please visit paceuone.com for instructions .
Form W-4  (Fill in PDF) Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Complete to either withhold federal taxes or claim exemption, providing employee meets criteria for exemption.Consider completing a new Form W-4 each year and when your personal or financial situation changes.  
Staff Employee Handbook Acknowledgment  (Fill in PDF) Complete to acknowledge you received the Employee Handbook. For STAFF only: Faculty may request a Handbook through their Department Chair.
IT Acknowledgement Form  (Word) Complete to acknowledge you received the IT Appropriate Use Policy and the Admin System User Statement.

Drug & Alcohol/Sexual Harassment Acknowledgement Form  (Word)

Complete to acknowledge you received the Policy on Alcohol and Drug Abuse and Drug Free Environment and Policy on Sexual Harassment
IT-2104 - Employee's Withholding Allowance Certificate and Instructions (NYS)  (Fill in Pdf) Complete to withhold New York State taxes, if you are working within New York state

IT-2104-1 Certificate of Nonresidence & Allocation of Withholding  (Fill in Pdf)

Complete to claim Nonresidence & Allocation of Withholding
IT-2104-E Certificate of Exemption from Withholding  (Fill in Pdf) Complete to claim exemption from withholding for New York State personal income tax
8233 - Exemption From Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual  (Pdf) Complete only if a non-resident alien is claiming exemption from taxes based upon their country's treaty with the US. Required for international students and faculty on work visa.

Benefits Forms for New Employee Orientation
Fax completed forms to 914-989-8506 or Scan/E-Mail to benefits@pace.edu

New Hire Benefits Checklist

Please return this completed checklist together with the forms listed below, to the University Benefits office within 31 days of your full-time date of hire.

Benefits Election Form

Please select your medical plan and dental plan options and level of coverage. If you are not electing medical coverage, be sure to return the completed Medical Plan Waiver form. In addition, please acknowledge your enrollment in Basic life insurance coverage (which is provided at no cost to you) and/or Voluntary life insurance coverage (for which you will be charged a semi-monthly premium). Please return this form within 31 days of your full-time date of hire.
Medical Plan Enrollment Form Please complete this form to enroll in medical coverage for yourself as well as for your eligible dependents (vision coverage is included with the election of a medical plan). If you are waiving medical coverage, indicate that you are declining coverage and be sure to specify whether or not you will be enrolling in CIGNA Vision coverage separately.  Complete the Medical Plan Waiver form to receive your semi-monthly reimbursement. Please return this form within 31 days of your full-time date of hire.
Medical Plan Waiver Please complete this form if you have other medical coverage and are electing to waive participation in the University’s medical insurance. This waiver must accompany your completed Medical Plan Enrollment Form. Please return this form within 31 days of your full-time date of hire.
Dental Enrollment Form Please complete Parts B, C, and D of this form to enroll in dental coverage. If you are electing the CIGNA Dental Care (DHMO) option, please be sure to list your Dental Office Selection in Part C. If you are declining dental coverage, please complete Part B of the form and write “I decline dental coverage” at the top of your form and sign/date Part D. Please return this form within 31 days of your full-time date of hire.
403(b) Retirement Plan University Contribution Eligibility Acknowledgement Please complete this form to confirm your understanding of the age and years of service requirement to receive the University contribution to your 403(b) Retirement Plan. Please return this form within 31 days of your full-time date of hire.
403(b) Retirement Plan – Waiting Period Waiver If applicable, please complete Section A of this form and submit to your previous employer for completion of Section B. Please have your previous employer return the form to you for submission to the University Benefits office. You will be notified if you are eligible to waive the waiting period to receive the University contribution of 9% (which is contingent upon your required 3% contribution) to the 403(b) Retirement Plan.
403(b) Salary Reduction Agreement Form Please complete this form, and open an account online with TIAA-CREF, to participate in the University’s 403(b) Defined Contribution Retirement Plan. Your election will rollover from calendar year to calendar year, unless you make a change.
Group Term Life Insurance  (Enrollment) Form Please complete this form to elect Voluntary life insurance coverage and/or Dependent life insurance coverage. Voluntary life insurance, in excess of $400,000, must have underwriting approval by the carrier. Please complete Page 2, Evidence of Insurability, if you are requesting Voluntary life insurance in excess of $400,000. Please return this form within 31 days of your full-time date of hire.
Life Insurance Beneficiary Designation Form Please complete this form to designate a beneficiary (or beneficiaries) for your Basic and Voluntary, if applicable, life insurance coverage. Please be sure to include the percentage of benefit for each beneficiary listed. You may change your beneficiaries, at any time, by submitting an updated form. Please return this form within 31 days of your full-time date of hire.
Flexible Spending Account/Health Savings Account Enrollment Form

Please complete this form to enroll in the Health Care Flexible Spending Account and/or Dependent Child Care Flexible Spending Account and/or the Health Savings Account (HSA). You may only enroll in the HSA if you have elected to participate in the CIGNA HDHP medical plan. Enrollment in the Health Care FSA and the Health Savings Account   (HSA) is prohibited. Your election will continue through June 30th. Please return this form within 31 days of your full-time date of hire.

Commuter Reimbursement Plan Enrollment Form Please complete this form to enroll in the Mass Transit or Parking Commuter Reimbursement Account. Your election will roll over from calendar year to calendar year, unless you make a change.
Long-Term Disability Plan – Waiting Period Waiver If applicable, please complete Section A of this form and submit to your previous employer for completion of Section B. Please have your previous employer return the form to you for submission to the University Benefits office. You will be notified if you are eligible to waive the one-year waiting period to enroll in the Long-Term Disability Plan.
Long Term Care - Benefit Election Form Although an employee may apply for Long Term Care insurance at any time during the plan year, the Evidence of Insurability requirement is waived, for the employee only, if he/she enrolls within the initial 31-day eligibility period (unless an option of $7,000, $8,000 or Unlimited Duration coverage is elected). Please access http://w3.unumprovident.com/enroll/pace for further information.
Long Term Care - Evidence of Insurability Evidence of Insurability is required of an employee if he/she enrolls after the 31-day initial enrollment period or chooses to purchase $7,000, $8,000, or Unlimited Duration coverage. Evidence of Insurability is required for all family members. Evidence of Insurability requires carrier underwriting approval. Please access http://w3.unumprovident.com/enroll/pace for further information.
Benefits Eligibility Acknowledgement Please complete this form to confirm your understanding of the 31-day initial enrollment period for medical, dental, life insurance, and Flexible Spending Account or Health Savings Account (HSA) participation. Your signature on this form also verifies that you have reviewed the online 2013-2014 Benefits @ Pace booklet. Please return this form within 31 days of your full-time date of hire.