San Jose State University : Human Resources

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HR Faculty Forms

ALL FACULTY FORMS

 

Accidents
Special Event Report of Injury or Loss (PDF)
State Driver Accident Review (PDF)
Student Accident Report (.doc)
Vehicle Accident Identification Card (PDF)
Vehicle Accident Report (PDF)
Visitor Accident Report (.doc)
Benefits
Affidavit of Marriage (PDF)
Disclosure of Privacy Information Worksheet (PDF)
eBenefit Self-service Electronic Signature Form (PDF)
Employer Zip Code Election (PDF)
TSA 403b Salary Reduction Agreement (PDF)
Benefits COBRA
COBRA Continuation Election (PDF)
Benefits, Supplemental Saving Program
CSU Certification of Establishment 403b TSA (PDF)
Tax Sheltered Annuity Final Settlement Deductions (PDF)
US Saving Bonds Purchase/Payroll Deduction Authorization (PDF)
Benefits, Vision
VSP Out-of-Network Reimbursement (PDF)
VSP Video Display Terminal Confirmation (PDF)
Discrimination
Discrimination Complaint Form (PDF)
Domestic Partners
Declaration of Domestic Partnership (PDF)
Domestic Partner Dependent Certification (PDF)
Employee Separation
Confidential Exit Survey (.doc)
Employee Clearance (.doc)
Employee Profile
Employee Profile (PDF)
Release of Confidential Information (PDF)
Employment
Auxiliary Appointment (.doc)
Emeritus Faculty Appointment (.doc)
CSU SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF)
Notice of Alternate Work Schedule (.doc)
Special Consultant Payment (.doc)
Faculty Care Medical Leave
Employees Request for Leave of Absence (PDF)
FCML Certification (PDF)
Return to Work Certification (PDF)
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)

ALL FACULTY FORMS

 

Leave Programs
Catastrophic Leave Medical Certification (PDF)
Difference in Pay Military Worksheet (PDF)
Election to Continue Direct Pay for Employees on Leave of Absence (PDF)
Request for Catastrophic Leave Donations (.doc)
Request for Leave of Absence (PDF)
Request to Participate in the Catastrophic Leave Donation Program (PDF)
Parking
Pre-Tax Parking Deduction Election Authorization (PDF)
Payroll
Absence and Addition Time Worked Report (.xls)
Authorization for Extra Hours (Overtime) (.doc)
Cancellation of Payroll Deduction (PDF)
CSU Certification of Establishment of 403(b)Tax Sheltered Annuity Account (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 (.doc)
Request for Salary Advance (.doc)
Request for Substitute Faculty Payment (.doc)
Special Consultant Payment (.doc)
Safety
Ergonomic Self Evaluation Worksheet (PDF)
General Safety Inspection Checklist(PDF)
Hazard Assessment Survey And Analysis Personal Protective Equipment (.doc)
Indoor Air Quality Questionnaire (PDF)
Injury and Illness Prevention Program Checklist (.doc)
Special Events
Special Event Report of Injury or Loss (PDF)
Special Event Liability Insurance Request(PDF)
Special Events Release Agreement (PDF)
Travel
Conduct Agreement (PDF)
Student Accident Report (PDF)
Student Travel Informed Consent (PDF)
University Activity Release Agreement Guidlines (PDF)
Vehicle Operation
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
Volunteer Appointment (.doc)
Worker's Compensation
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 (.doc)
Notice of Pre-designation of Personal Physician (PDF)
Workers' Compensation Facts for New Employees (PDF)

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