San José State University : Human Resources : HR Confidential Forms

HR Confidential Forms

ALL MPP/CONFIDENTIAL EMPLOYEE FORMS
Accidents	top
Special Event Report of Injury or Loss (PDF)
State Driver Accident Review (PDF)
Student Accident Report Form (PDF)
Vehicle Accident Identification Card (PDF)
Vehicle Accident Report (PDF)
Visitor Accident Report (PDF)
Benefits	top
Affidavit of Marriage (PDF)
eBenefit Self-service Electronic Signature Form (pdf)
Employer Zip Code Election (PDF)
Benefits, Supplemental Saving Program	top
Tax Sheltered Annuity Final Settlement Deductions (PDF)
Benefits, Vision	top
VSP Out-of-Network Reimbursement (PDF)
VSP Video Display Terminal Confirmation (PDF)
Discrimination	top
Employee Discrimination and Harassment Complaint Form (PDF)
Domestic Partners	top
Declaration of Domestic Partnership (PDF)
Domestic Partner Dependent Certification (PDF)
Employee Separation	top
Confidential Exit Survey (.pdf)
Employee Clearance (PDF)
Employee Profile	top
Employee Profile (PDF)
Release of Confidential Information (PDF)
Employment	top
Auxiliary Appointment (PDF)
CSU SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF)
Notice of Alternate Work Schedule (PDF)
Family Care Medical Leave	top
Employee Medical Certification (PDF)
Family Medical Certification (PDF)
Leave of Absence Request Form (PDF)
Return to Work Certification (PDF)
Fee Waiver	top
Continuing Staff Career Development Update Application (PDF)
Staff Dependent Fee Wavier Entitlement Transfer (PDF)
Staff Fee Waiver Application for Change of Courses (PDF)
Staff Fee Waiver Career Development Application (PDF)
Staff Fee Waiver Job Related Application (PDF)
Health Insurance Portability And Accountability Act (HIPAA)	top
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)

ALL MPP/CONFIDENTIAL EMPLOYEE FORMS
Health and Safety	top
Ergonomic Self Evaluation Worksheet (PDF)
Leave Programs	top
Catastrophic Leave Donation Program Participation Request (PDF)
Catastrophic Leave Donation Requst (PDF)
Catastrophic Leave Medical Certification (PDF)
Certification of Health Care Provider for Employee's Pregnancy Disability (PDF)
Difference in Pay Military Worksheet (PDF)
Election to Continue Direct Pay for Employees on Leave of Absence (PDF)
Leave of Absence Request Form (PDF)
Leave Without Pay Form (PDF)
Parking	top
Pre-Tax Parking Deduction Election Authorization (PDF)
Payroll	top
Authorization for Extra Hours (Overtime) (PDF)
Cancellation of Payroll Deduction (PDF)
Direct Deposit Enrollment Authorization (PDF)
Duplicate W2 Wage and Tax Statement Request Form (PDF)
Employee Action Request EAR (PDF)
Employee Appointment Form (PDF)
Hourly Time Sheet (.xls)
Reporting Informal Leave without Pay (Docks) (PDF)
Request for Excess Vacation Accrual Carry-Over (PDF)
Special Consultant Payment (PDF)
Substitute Faculty Payment Request (PDF)
Performance Review	top
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.
Special Events	top
Salary Advance Request (PDF)
Special Event Report of Injury or Loss (PDF)
Special Events Liability Insurance Request (PDF)
Special Events Release Agreement (PDF)
Travel	top
Conduct Agreement (PDF)
Release of Liability Form (PDF)
Vehicle	top
Application for University Vehicle Operation Authorization (PDF)
Authorization to Use Privately Owned Vehicles on State Business (PDF)
State Driver Accident Review (PDF)
Vehicle Accident Identification Card (PDF)
Vehicle Accident Report (PDF)
Volunteering	top
Volunteer Request and Appointment Package (PDF)
Worker's Compensation	top
Employers Report of Occupational Injury or Illness (PDF)
Notice of Personal Chiropractor or Acupuncturist (PDF)
Workers Compensation Claim Form (DWC 1) And Notice of Potential Eligibility (PDF)
Occupational Injury or Illness Checklist (PDF)
Notice of Pre-designation of Personal Physician (PDF)
Workers' Compensation Facts for New Employees (PDF)

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Human Resources
One Washington Square
San José, CA 95192-0046

Office: 408.924.2250
TTY: 408.924.2265
Fax: 408.924.2284

Located in the UPD Bldg, Third Floor
Hours: M - F, 8AM to 5PM

Important: Documents in PDF format require the free Adobe Acrobat Reader for viewing.

San Jose State University : Human Resources

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