Forms

Attention Staff

Some forms require Chart Field Strings.

New Form for Managers!

The Information Technology Services department has created a new form to assist managers in identifying digital resources that require attention when an employee separates from their unit or the University, including leaves of absence. Managers are encouraged to review the new form and use it to secure digitial resources when appropriate.

•   Separating Employee Check List for Digital Resources

New Employee Forms

• New Employee Checklist
• I-9 Form - Social Security Card must be presented for State Controller's Office verification.
• Social Security Office - Replacement card/name change application.
• Employee Information Form (EIF)
• Employee Action Request (EAR Form)
• CSU Family Medical Leave Policy Notice to Employees
• IRS W-4 worksheet - This is for your information only and does not replace the EAR form.
• Confidentiality Statement for Employees, Consultants & Contractors (student assistants may also use this form)
• Confidentiality Statement for Faculty
• Confidentiality Statement for Academic Professionals (Unit 4)
• Direct Deposit Form
• CMS / PeopleSoft Access Form - This is required for PeopleSoft & Data Warehouse access.

Student Employee Forms

• New Student Wage Schedule
• IRS W-4 worksheet - This is for your information only and does not replace the SPAR form.

Student Assistants and Work Study

Please complete the SPAR, I-9, and SSA-1945

• Please read this important information regarding SPAR forms.
• *NEW* Hints for completing the SPAR form!
• Student Payroll Action Request (SPAR) - Use this form for Student Assistants and Work Study. Please Note: No residence hall addresses accepted.
• I-9 Form - Social Security Card must be presented for California State Controller's Office verification.
• SSA-1945 Form

• CSU Family Medical Leave Policy Notice to Employees
• Confidentiality Statement for Employees, Consultants & Contractors (student assistants may also use this form if a department requires a confidentiality form)

 

Instructional Student Assistant, Graduate Assistant, & Teaching Associate

Please complete the EAR, EIF, and I-9

• Employee Action Request (EAR) - No dormitory addresses accepted.
• Employee Information Form (EIF)
• CSU Family Medical Leave Policy Notice to Employees
• I-9 Form - Social Security Card must be presented for California State Controller's Office verification.)
• Confidentiality Statement for Employees, Consultants & Contractors

 

Administrative Forms

• Grant Furlough Exemption Form - Used for grant-funded employees that receive a State check.
• Form 104 - Report of Appointment for Staff - Please Print on yellow paper and include Chart Field String.
• Position Change Form - Please use when funding changes are needed for current employees.
• Instructions to Complete Digital Signature on Position Change Form
• 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 Checklist for Digital Resources
• Separating Employee Clearance Form - This must be completed before final pay check is issued.
• Separating Housing Employee Clearance Form
• Separating Management Employee Clearance Form
• Special Consultant Request Instructions
• Special Consultant Request
• Volunteer Policy
• Volunteer Form
• Volunteer Form Processing Instructions

Benefit Forms

• HBD-12 - Health Benefits Enrollment Form - (Medical Benefits worksheet)
• HBD-12A - Declaration of Health Coverage - (Medical Benefits worksheet)
• Dental Enrollment Authorization (STD-692)
• Vision Insurance - Add Dependents
• 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. IMPORTANT NOTE:  The effective date of enrollment for Flex Cash is contingent upon your paperwork being completed and received in the State Controller’s Office. 
• Health Care/Dependent/Care Reimbursement Account Claim Form
• CAL-ORE Life Flight Membership Form
• CalPERS Beneficiary Designation Form
• Domestic Partner Information
• Domestic Partner Forms
• 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- Offer of Appointment- Within 5% of Minimum Range
• Form 5 - Request to Vice President to Offer Appointment-Over 5% of Minimum Range
• Employment Release of Information Form - Use only when an HSU application is not required.
• Background and Criminal Records Check Policy and Procedures
• University Police Department (Live Scan/Fingerprinting Information)
• Request for Live Scan Service Form (Fingerprinting)
• 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)
• 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 Denise Giltzow by e-mail or at (707) 826-5173.
• Adobe Acrobat Reader

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