Forms by Category
Accidents
- Special Event Report of Injury or Loss (PDF)
- State Driver Accident Review Form (STD 274) (PDF)
- Student Accident Report Form (PDF)
- Vehicle Accident Identification Card (STD 269) (PDF)
- Student Accident Report Form (PDF)
- Visitor Accident Report (PDF)
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Benefits
- Affidavit for Employees-Gender Verification of Married Persons and Imputed Tax (PDF)
- Affidavit of Marriage/Domestic Partnership (PDF)
- Affidavit of Parent-Child Relationship (PDF)
- CSU SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF)
- Disclosure of Privacy Information Worksheet (PDF)
- eBenefits Self-service Electronic Signature Form (PDF)
- Employer Zip Code Election Form (PDF)
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Benefits, Supplemental Saving Program
Benefits, Vision
Child Abuse - Mandatory Reporting
- Child Abuse - Executive Order 1083 (PDF)
- Child Abuse - Executive Order 1083, Attachment A - Acknowledgment of Mandated Reporter Status (PDF)
- Child Abuse - Executive Order 1083, Attachment B - Certificate of Training Completion (PDF)
- Child Abuse - Executive Order 1083, Attachment C - Penal Code Sections 11165.7, 11166, and 11167 (PDF)
- Child Abuse - Executive Order 1083, Attachment D - Suspected Child Abuse Report Form SS 8872 (PDF)
- Child Abuse - Executive Order 1083, Attachment D - Suspected Child Abuse Report Form
SS 8872 - Definitions and General Instructions (PDF)
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Classification and Compensation
- Classification and Compensation Review Form (Staff) (PDF)
- Position Description Questionnaire (PDF)
- Position Description Template (.docx)
- Salary Stipend Request for CSUEU Employees (PDF)
Confidentiality
- Buckley Amendment (PDF)
- Confidentiality Agreement (PDF)
- Confidentiality Statement, Recruitment Selection Process (PDF)
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Conflict of Interest
- Conflict of Interest Form 700: Statement of Economic Interests (PDF)
- Conflict of Interest Form 700-U: Statement of Economic Interests for Principal Investigators (PDF)
- Conflict of Interest Form 801: Gift to Agency (PDF)
- Conflict of Interest Form 802: Tickets Provided by Agency Reporting and Instructions (PDF)
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Data and Technical
- Data Request (PDF)
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Discrimination
- Employee Discrimination Complaint Form (PDF)
- Student Discrimination/Harassment Complaint Form (PDF)
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Domestic Partners
Employee Separation
Employee Profile
Health and Safety
- Ergonomic Self Evaluation Worksheet (PDF)
- General Safety Inspection Checklist (PDF)
- Hazard Assessment Survey and Analysis Personal Equipment (PDF)
- Indoor Air Quality Questionnaire (PDF)
- Injury and Illness Prevention Program Checklist (PDF)
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Health Insurance Portability And Accountability Act (HIPAA)
- Authorization to Use and/or Disclose Personal Health Plan Information (PDF)
- Request for Access to Inspect and Copy Personal Health Plan Information (PDF)
- Request for Accounting of Non-Routine Disclosures of Personal Health Plan Information (PDF)
- Request for Confidential Communications of Personal Health Plan Information (PDF)
- Request for Restricted Use of Personal Health Plan Information (PDF)
- Request to Amend Personal Health Plan Information (PDF)
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Leave
- Election to Continue Direct Pay for Employees on Leave of Absence (PDF)
- Leave of Absence Request Form (PDF)
- Leave Without Pay Request Form (PDF)
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Leave, Catastrophic
- Catastrophic Leave Donation Program Participation Request (PDF)
- Catastrophic Leave Donation Request (PDF)
- Catastrophic Leave Medical Certification (PDF)
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Leave, Family Medical
- Employee Medical Certification (PDF)
- Family Medical Certification (PDF)
- FCML Departmental Checklist (PDF)
- Leave of Absence Request Form (PDF)
- Return to Work Certification (PDF)
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Leave, Other Programs
- Certification of Health Care Provider for Employee's Pregnancy Disability (PDF)
- Certification of Qualifying Exigency for Military Family Leave Form (PDF)
- Certification of Serious Injury or Illness of Covered Service Member Military Family Leave (PDF)
- Difference in Pay Military Worksheet (PDF)
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Parking
Payroll
- Authorization for Extra Hours (Overtime) (PDF)
- Cancellation of Payroll Deduction (PDF)
- Designation of Person Authorized to Receive Warrants (PDF)
- Direct Deposit Enrollment Authorization (PDF)
- Duplicate W2 Wage and Tax Statement Request Form (PDF)
- Employee Action Request Form (PDF)
- Employment Appointment Form (PDF)
- Excess Vacation Accrual CarryOver (PDF)
- Hourly Time Sheet (.xls)
- Notice of Alternate Work Schedule (PDF)
- Reporting Informal Leave without Pay (Docks) (PDF)
- Salary Advance Request (PDF)
- Special Consultant Payment (PDF)
- Substitute Faculty Payment Request (PDF)
- Warrant Release Authorization Form (PDF)
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Performance Review - APC (Unit 4)
- Report of Employee Performance Unit 4 Academic Support (PDF)
- Staff Performance Review Guidelines for Writing Effective Goals Worksheet (PDF)
- Staff Pre-Performance Review Worksheet Units 1, 4, 8 (PDF)
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Performance Review - CSUEU (Units 2,5,7,9)
- Staff Performance Review Form Units 2, 5, 7, 9 (CSUEU) (.xls)
- Staff Pre-Performance Review Worksheet Units 2, 5, 7, 9 (CSUEU) (PDF)
- Staff Probationary Review Form Units 2, 5, 7, 9 (CSUEU) (.xls)
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Performance Review - MPP/Confidential
- MPP/Confidential Performance Review Process and Forms (PDF) Must have Acrobat Professional to save typed data in this form. Otherwise, use .doc form below.
- MPP/Confidential Performance Review Process and Forms (.doc) Use this form for reviews if you have Microsoft Word.
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Performance Review - SETC (Unit 6)
- SETC Annual Review (.xls)
- SETC Pre-Performance Review Worksheet (PDF)
- SETC Probationary Review (.xls)
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Performance Review - UAPD (Unit 1) and SUPA (Unit 8)
- Staff Performance Review Units 1 and 8 (.xls)
- Staff Performance Review Guidelines for Writing Effective Goals Worksheet (PDF)
- Staff Pre-Performance Review Worksheet Units 1, 4, 8 (PDF)
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Person of Interest
Position Management
Recruitment
- Application Review Evaluation (PDF)
- Essential Duties and Responsibilities Checklist (PDF)
- Fingerprinting and Criminal History Record Check, for Animal Care Lab Employees (PDF)
- Fingerprinting and Criminal History Record Check, for Unescorted Access to Radioactive Material in Quantities of Concern (PDF)
- Interview Evaluation On-Site (PDF)
- Interview Evaluation Telephone (PDF)
- Live Scan Fingerprinting Process and Responsibilities (PDF)
- Live Scan Memo to Finalists Template (PDF)
- Reference and Background Check (PDF)
- Temporary Support Request (PDF)
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Release of Liability & Travel
- Release of Liability Handbook (PDF)
- Release of Liability Form (PDF)
- Student Conduct Agreement (PDF)
- Student Travel Informed Consent (PDF)
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Special Events
- Special Event Report of Injury or Loss (PDF)
- Special Events Liability Insurance Request (PDF)
- Special Events Release Agreement (PDF)
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Student Assistant/Work Study
- Application for Workstudy or Student Assistant Position (PDF) - for hiring department's use only, do not forward to HR
- Student Assistant Appointment Form (PDF) (see the List of Acceptable docs, last page of DOHS Form I-9)
- Student Assistant Orientation Checklist (PDF)
- Student Employee Evaluation (PDF)
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Tuition Fee Waiver
- Staff Dependent Fee Waiver Entitlement Transfer Form (PDF)
- Staff Fee Waiver Application for Change of Courses (PDF)
- Staff Fee Waiver Career Development Application (PDF)
- Staff Fee Waiver Continuing Staff Career Development Update Application (PDF)
- Staff Fee Waiver Job Related Application (PDF)
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Vehicle Operation
- Application for University Vehicle Operation Authorization (PDF)
- Authorization to Use Privately Owned Vehicles on State Business (STD 261) (PDF)
- State Driver Accident Review Form (STD 274) (PDF)
- Vehicle Accident Identification Card (PDF)
- Vehicle Accident Report Form (STD 270) (PDF)
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Veteran Status
Volunteering
Worker's Compensation
- Employer's Report of Occupational Injury or Illness (PDF)
- Notice of Personal Chiropractor or Acupuncturist (PDF)
- Notice of Pre-designation of Personal Physician (PDF)
- Occupational Injury or Illness Checklist (PDF)
- Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (PDF) (PDF)
- Workers' Compensation Benefit Information (PDF)
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Waivers
- Release of Liability Form (PDF)
- Release of Liability Handbook (PDF)
- Student Conduct Agreement (PDF)
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