San José State University : Human Resources : HR Faculty Forms

HR Faculty Forms

ALL FACULTY FORMS
Accidents	top
Special Event Report of Injury or Loss (PDF)
State Driver Accident Review (PDF)
Student Accident Report (PDF)
Vehicle Accident Identification Card (PDF)
Vehicle Accident Report (PDF)
Visitor Accident Report (PDF)
Benefits	top
Affidavit of Marriage (PDF)
Disclosure of Privacy Information Worksheet (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
Separation Process and forms please see the Office of Faculty Affairs
Employee Clearance (PDF)
Employee Profile	top
Employee Profile (PDF)
Release of Confidential Information see the Office of Faculty Affairs
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)
Special Consultant Payment (PDF)
Faculty Care Medical Leave	top
Faculty Request for Leave of Absence please see the Office of Faculty Affairs
Employee Medical Certification (PDF)
Family Medical Certification (PDF)
Return to Work Certification (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 FACULTY FORMS
Leave Programs	top
Catastrophic Leave Donation Program Participation Request (PDF)
Catastrophic Leave Donation Request (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)
Leaves of Absence see Office of Faculty Affairs
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)
Salary Advance Request (PDF)
Special Consultant Payment (PDF)
Substitute Faculty Payment Request (PDF)
Safety	top
Ergonomic Self Evaluation Worksheet (PDF)
General Safety Inspection Checklist(PDF)
Hazard Assessment Survey And Analysis Personal Protective Equipment (PDF)
Indoor Air Quality Questionnaire (PDF)
Injury and Illness Prevention Program Checklist (PDF)
Special Events	top
Special Event Report of Injury or Loss (PDF)
Special Event Liability Insurance Request(PDF)
Special Events Release Agreement (PDF)
Travel	top
Conduct Agreement (PDF)
Release of Liability (PDF)
Student Accident Report (PDF)
Student Travel Informed Consent (PDF)
Vehicle Operation	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
Process and forms for Volunteering are on the Office of Faculty Affairs website.
Worker's Compensation	top
Employer's 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)

Additional forms for various faculty processes can be located on the Office of Faculty Affairs website. Or, try looking at the All Forms page; it includes the complete database of all the HR forms!

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

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San Jose State University : Human Resources

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