Forms

Attention Staff: Some forms require Chart Field Strings.

New Employee Forms

• I-9 Form
• Social Security Card or copy must be presented for verification. Social Security Office - Replacement card/name change application.
• Employee Information Form
• Employee Action Request (EAR Form)
• IRS W-4 worksheet - This is for your information only and does not replace the EAR form.
• Confidentiality Statement for Employees, Consultants & Contractors
• Confidentiality Statement for Faculty
• Direct Deposit Form
• CMS Access Form - This is required for PeopleSoft & Hyperion access.

Student Employee Forms

• New Student Wage Schedule
• Please read this important information regarding SPAR forms.
• Student Payroll Action Request (SPAR) - Please Note: No dormitory addresses accepted.
• IRS W-4 worksheet - This is for your information only and does not replace the SPAR form.
• I-9 Form (Social Security Card or copy must be presented for verification.)
• SSA-1945 Form

Administrative Forms

• Form 104 - Report of Appointment for Staff - Please Print on yellow paper and include Chart Field String.
• Position Number Change Form - Please use when funding changes are needed for current employees.
• Application Procedures for Leave of Absence with out Pay
• Form 107 - Application for Leave of Absence for Support Staff - Please print on pink paper.
• Form 109 - Report of Separation for Staff - Please print on green paper.
• Separating Employee Clearance Form - This must be completed before final pay check is issued.
• Separating Housing Employee Clearance Form
• Special Consultant Request Instructions
• Special Consultant Request
• Volunteer Policy and Form

Benefit Forms

• HBD-12 - Health Benefits Enrollment Form - (Medical Benefits worksheet)
• Dental Enrollment Authorization (STD-692)
• VSP Vision Insurance Claim - No form required for vision services
• VSP Out-of-Network Reimbursement Form
• VSP Video Display Terminal (VDT) Claim Form - Please take to your eye care professional.
• Flex Cash Enrollment Authorization Form - Please complete and bring to Human Resources with proof of other insurance coverage.
• Health Care/Dependent/Care Reimbursement Account Claim Form
• CAL-ORE Life Flight Membership Form
• 403(b) Salary Reduction Agreement for Tax Sheltered Annuity
• 403(b) Maximum Contribution Catch-Up Worksheet
• 403(b) Instructions - Maximum Contribution Worksheet
• CalPERS Beneficiary Designation Form
• Domestic Partner Information and Forms
• Savings Bond Form
• Supervisor's Injury Prevention Report
• Employee's Claim Form For Worker's Compensation Benefits
• Workers Compensation Pre-Designation of Physician Form
• CSU Fee Waiver Program Information

Recruitment Forms

• Staff Recruitment Handbook
• Form 1 - Authorization to Recruit
• Form 2 (Confidential Application Log) - Completed by Human Resources
• Form 3 - Interview Request
• Form 4 - Selection Committee Hiring Recommendation
• Form 5 - Request to Vice President to Offer Appointment
• Documentation on Disabled/Covered Veteran - Please fill out at completion of search.
• Employment Information Release Form - Use only when an HSU application is not required.
• Reimbursement Request - Use only when a department is paying for travel expenses of interviewed candidates.
• HSU Employment Application - This must be completed and signed by applicants when specified in the job announcement.

Staff Forms

• Staff Evaluation Forms
• W-2 (replacement request)
• Performance Pay Salary Increase Recommendation - Unit 4
• Position Description/Classification Guide
• Position Description Form (PDF)
• Position Description Form (Word)
• Whistleblower Complaint Form

Miscellaneous

• Required Notification for Employees Not Covered by Social Security (SSA-1945 Form)
• If you need assistance with any of the above-listed forms, please contact Jeff Dixon by e-mail or at (707) 826-5150.
• Adobe Acrobat Reader

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