Frequently Requested Forms

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TRAINEE APPOINTMENT AND COMPLETION FORMS

Appointment Letter -Updated 12/6/2012
Contract Request Form (Residents & Fellows) -Updated 1/2013
Certificate Engrossing Request Form
IU Health Hospital Pharmacy Signature Form
Exit Form for Terminating House Staff
Health Services Authorization to Medical Release Information Form
House Staff Information Form
Health Services Immunization Form (also known as Resident Immunization Verification Form)
Tuberculosis Questionnaire
Jagtag/School of Medicine ID Card Expense Authorization Form
Motor Vehicle Records Check Form
Patent Agreement Form
Visiting House Staff Assignment Form - Updated 2/2013
TB Respirator Questionnaire *for fit testing and TB masks
Wishard Hospital Pharmacy Signature Form

Background Check Information and Forms
*Copy of resident/fellow CV requested with formsUpdate
Policies and Procedures for Requesting Background Checks
Acknowledgement of Receipt of Conditions and Requirements for Appointment
Consent to Background Check
Background Check Self-Disclosure Questionnaire
Statement of Principles-Honor Code

BENEFIT FORMS

PAYROLL FORMS

Direct Bank Deposit Form
*Note: The Payroll Department prefers that direct deposit information be changed electronically via OneStart. To log into OneStart, click here. Direct deposit changes can be made in the "Employee Self-Service" menu on the right.
W-4 Tax Form (Federal)
WH-4 Tax Form (State)
W-4 Federal Tax Form for Non-Resident Aliens
International Tax Questionnaire (International Medical Grads)

MISCELLANEOUS FORMS

VAMC FORMS

Fesler Hall is located south of Riley hospital;
west of the Nursing School.

Resources