• RAMAPO EMPLOYEE ACCOMMODATION REQUEST FORM (writable)
• MEDICAL INQUIRY FORM FOR ADA Ramapo – Writable

• ABP Enrollment Application
• Retirement application (PDF)
• Alternate Benefits Program (ABP) Carrier Election and Allocation Form(Writable PDF)
• Designation of Beneficiary Form (PDF)
• Designated Service Providers Comparison Guide
• Long Term Disability Application (PDF)
• Pension Loan Verification Form (Writable PDF)
• Hardship Withdrawal Request Form (writable PDF)
• Alternate Benefit Program Withdrawal Request Acknowledgement Receipt
• ABP Fact Sheet

• Alternative Work Arrangement Agreement (AWA) – (Writable PDF)

• Business Card Printing Authorization Form
  • Digital Signature – once the form opens, download it and save it to your computer & open with Adobe Acrobat (Digital Signature Instructions)
• Procedure (PDF)

Please fill out the form below for either Part-time or Full-time employee:

• Change of Address (PT) (Writeable PDF) Internal Ramapo Form
• Change of Address (FT Faculty & Staff) Writeable PDF – Internal Ramapo Form – Please return form to Benefits

In addition to filling out the form above, please make your address change with your Health Benefits:

• Health Benefits – need myNJ account – link to website:  myNJ  (Benefitsolver) – Guide link for instructions – click here:  Guide 
• ABP Members contact your vendor.

• Enrollment Form (PDF)
• Beneficiary Change Form (PDF)
• Deferral Rate Change Form (PDF)
• Allocation Change Form (PDF)
• Catch Up Election Form (PDF)

• Dental Plans Member Handbook
• Dental Plans Fact Sheet
• Dental Plan Websites
• SHBP Employee Dental Plans Claim Form (PDF)
• Dental Rates

• Driver’s License Abstract (writable PDF)

• See Alternate Work Arrangement Agreement (AWA)

• Summary Program Description/All Plans(PDF)
• Summary of Plans – CWA , Union Negotiated & Non-aligned
• Health Plan Member Handbooks
• Horizon Website Link
• Health Savings Account Form(PDF)
• NJ Direct Claim Form (PDF)
• How to register for My.QuestForHealth.com to access the Physician Results Form
• SBC Postcard 2021
• Employee Guide to Logging into Benefitsolver

• FMLA Poster (PDF)
• FMLA Poster-Spanish (PDF)
• Domestic Violence Victim Leave Law
• Request for Leave of Absence Form (DOC)
• Certification of Healthcare Provider for Employee’s Serious Health Condition (PDF)
• Certification of Healthcare Provider for Family Member’s Serious Health Condition (PDF)
• Certification of Qualifying Exigency for Military Family Leave (PDF)
• Certification for Serious Injury or Illness of Covered Service member for Military Family Leave (PDF)
• Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave(PDF)
• Department of Labor-Temporary Disability Insurance (PDF)
• FMLA Intermittent Absence Form (Writeable PDF)
• Family Leave Insurance Poster (PDF)
• Family Leave Insurance Information
• Physician Return to Work Authorization
• State Family Leave Insurance Benefits Claim Form (FL-1)
• FMLA FAQs
• FMLA Employee Guide

• Workers Compensation Procedures
• On the Job Injury Checklist
• Employer’s First Report of Accidental Injury or Occupational Illness (PDF)
• Horizon Casualty Treatment RX Form
• Employer’s Authorization and Referral for Workers’ Compensation

New Jersey Earned Sick Leave Law

Who is covered by the Law?

The New Jersey Earned Sick Leave Law extends earned sick leave benefits to employees who were not previously entitled to this benefit (i.e. adjuncts, temporary, hourly employees, and student workers).

What does the New Jersey Earned Sick Leave Law Provide?

Under the New Jersey Earned Sick Leave Law, eligible employees earn sick leave at the rate of one-hour for every 30 hours worked, up to a maximum of 40 hours of sick leave.

When can eligible employees start accruing sick leave?

Eligible employees will begin to accrue earned sick leave on October 29, 2018, or on their first day of employment, whichever is later.

When can eligible employees start using sick leave?

Eligible employees can begin using earned sick leave accrued under the New Jersey Earned Sick Leave Law the later of the 120^th day after the accrual date of October 29, 2018 on and after February 26, 2019 or the 120th calendar day after you begin employment.

Is advance notice required before I take a Sick Leave?

If your need for earned sick leave is foreseeable (can be planned in advance), you should as possible provide up to 7 days advance notice of your intention to use earned sick leave to your supervisor. If your need for earned sick leave is unforeseeable (cannot be planned in advance), provide notice as soon as it is practical to your supervisor.

Do I need to provide documentation when I use my Sick Leave?

Documentation is required, if you use earned sick leave on 3 or more consecutive work days, or on certain Blackout dates specified by your supervisor. However, the law prohibits employers from requiring your health care provider to specify the medical reason for your leave.

Can I carryover Sick Leave Days?

Yes, you may carry-over up to 40 hours of leave per benefit year. However, you can only use up to 40 hours of leave per benefit year.

What a reasons that I can use Sick Leave?

You can use earned Sick Leave when:

• You need diagnosis, care, treatment, or recovery for a mental or physical illness, injury, or health condi­tion; or you need preventive medical care.
• You need to care for a family member during diag­nosis, care, treatment, or recovery for a mental or physical illness, injury, or health condition; or your family member needs preventive medical care.
• You or a family member have been the victim of domestic violence or sexual violence and need time for treatment, counseling, or to prepare for legal proceedings.

• You need to attend school-related conferences, meetings, or events regarding your child’s education; or to attend a school-related meeting regarding your child’s health.
• Your employer’s business closes due to a public health emergency or you need to care for a child whose school or child care provider closed due to a public health emergency.

What is the definition of “Family Member”?

The law recognizes the following individuals as “family members:”

• • Child (biological, adopted, or foster child; stepchild; legal ward; child of a domestic partner or civil union partner)
  • Grandchild
  • Sibling
  • Spouse
  • Domestic partner or civil union partner
  • Grandparent
  • Spouse, domestic partner, or civil union partner of an employee’s parent or grandparent
  • Sibling of an employee’s spouse, domestic partner, or civil union partner
  • Any other individual related by blood to the employee
  • Any individual whose close association with the employee is the equivalent of family

If, I need to take a sick Leave day what is the current process?

Notify your Supervisor that you will be taking sick time for one of the eligible reasons listed above.

To take sick time, enter your sick hours using the Paid Sick Leave Code on your timesheet in Web Self-Service, once you sign on to submit your weekly hours.

You may view your available sick leave balance at any time in Web Self-Service by clicking Leave Balances under the Employee tab in Web Self-Service.

I am an Adjunct, Graduate Assistant or Coach and I do not submit my time via Web Self Service. How can I submit a Sick Leave request?

Notify your Supervisor that you will be taking sick time for one of the eligible reasons listed above.

Complete the NJ Employee Earned Sick Leave Request Form to request sick time. Enter your sick hours, date(s) you are requesting Earn Sick Leave. Provide the completed NJ Employee Earned Sick Leave Request Form to your Supervisor for review and approval. Your Supervisor will forward the completed form to Payroll for processing.

You may view your available sick leave balance at any time in Web Self-Service by clicking Leave Balances under the Employee tab in Web Self-Service.

What if I have already taken Sick Leave days?

Please send an email to the confidential email at SickLeave@ramapo.edu. Please include the days/hours that you were out due to one of the Sick Leave reasons listed above. Please include the reason you are taking Sick Leave.

Can Earned Sick Leave be charged to Federal Work Study?

No, NJ Earned Sick Leave may not be charged to Federal Work Study.

As a Supervisor can I view the available Leave Balances of my Direct Reports?

Yes, you can view the Leave Balances of your Direct Reports via Web Self-Service. Access the employees’ timesheet in the same manner that you access their record to approve their time. Click on the “Employee Tab, Select the Pay Type (RB or SB), Pay number, select the employees’ record and click the “Leave Balance” link located to on the last column on the far right of the employees’ record.

The New Jersey Earned Sick Leave which was posted as legally required may be viewed at https://nj.gov/labor/forms_pdfs/mw565sickleaveposter.pdf

• Performance Appraisal – Classified PAR 2022-2023 form for Employees
• Performance Appraisal – Classified PAR 2022-2023 form for Supervisors
• Performance Appraisal – Classified PAR 2023-2024 Form for Employees
• Performance Appraisal – Classified PAR 2023-2024 form for Supervisors
• PAR Overview
• Performance Appraisal – Managers

• OptumRx Website
• OptumRx Member Services: 1-844-368-8740
• Medicare Retirees: 1-844-368-8765

• • Link to MBOS
  • Online Guide to Retirement
  • PERS Member Guidebook
  • PERS Membership Tier Chart

• APPROVAL FOR RECRUITMENT AND HIRE FORM
• Financial Impact Statement template

Retiree Health Benefits

• Special Payment Form (Electronic Signature) Once the special payment form opens, download it and save to your computer, then open it with Adobe Acrobat
• Digital Signature Instructions
• EPAF is currently under review and not available at this time.
• User Training handbooks at the HR Training website

• • Tax$ave News
  • Open Enrollment Information
  • Flexible Spending Reference Guide
  • Enrollment Form Horizon MyWay
  • Link to Horizon MyWay
  • Commuter Tax$ave Fact Sheet

• Tuition Waiver Full Time AFT(PDF) (Electronic Signature) Once the form opens, download it and save it to your computer & open with Adobe Acrobat (Digital Signature Instructions)
• Tuition Waiver Non-AFT (PDF) (Electronic Signature) Once the form opens, download it and save it to your computer & open with Adobe Acrobat (Digital Signature Instructions)
• Tuition Waiver for Dependent (PDF) (Electronic Signature)  Once the form opens, download it and save it to your computer & open with Adobe Acrobat (Digital Signature Instructions)
• Tuition Assistance for Classified/Unclassified Staff (Non-AFT) (Electronic Signature)Once the form opens, download it and save to your computer & open with Adobe Acrobat  (Digital Signature Instructions)
• Tuition Reimbursement AFT

• Vision Care Request for Reimbursement (writable form)

• Voluntary Furlough Request Form(PDF) (Electronic Signature) Once the form opens, download and save it to your computer and open with Adobe Acrobat (Digital Signature Instructions)

• Fact Sheet #34 – The Additional Contributions Tax-Sheltered (ACTS) Program (PDF)
• Salary Reduction Agreement – Additional Contributions – Tax Sheltered (Writable PDF)

• Webtime Adjustment Correction Memo
• Procedure-for-Submitting-a-Missed-Timesheet-111510
• Timesheet Submission (If missed Web-Time Submission)

• • Horizon BCBS
  • NJ Well Information and Website