Loyola University Chicago

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Benefits Forms

• Benefits Selection Form - Lakeside Campuses (PDF)
• Benefits Selection Form - Stritch School of Medicine (PDF)
• BlueCross Claim Form (PDF)
• Delta Dental Claim Form (PDF)
• DHMO-IL Provider Selection Form (PDF)
• HMO-IL Provider Selection Form (PDF)
• FSA Reimbursement Request Form (PDF)
• VSP Claim Form (PDF)

Change of Address Form

• Change of Address Form

Conflict of Interest Disclosure Form

• Conflict of Interest Disclosure Form (PDF)

Direct Deposit Form

• Direct Deposit Form (PDF)

Disciplinary Report Form

• Disciplinary Report of Conference (PDF)
• Policy on Progressive Discipline   

Family Medical Leave Act (FMLA) Forms

• Request for FMLA (PDF)
• Healthcare Provider Certification (PDF)
• Healthcare Provider Return to Work Certification (PDF)
• FMLA Policy

Giving To Loyola Payroll Deduction Forms

• Payroll Deduction Form 2006 (PDF)
• Faculty and Staff Giving to Loyola Brochure (PDF)

Government Forms

• Federal I-9 Employment Eligibility Form (PDF) 
• Federal W-4 Form (PDF)
• Federal W-9 Form (PDF)
• Illinois Dept. of Revenue-Electronic Filing
• Illinois W-4 Form (PDF)    
• Statement of Non-Residence in Illinois

Leave of Absence Forms

• Request for LOA (PDF)
• LOA Policy

New Hire Forms

• New Employee Packet (PDF)
• Personal Action Form (Formatta)
• Register for Loyola Alert

Online Employment Applicant System

• Employment Applicant System (Hiring Officials Only)