San José State University : Human Resources : HR Staff Forms

HR Staff Forms

ALL STAFF 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)
eBenefit Self-service Electronic Signature Form (PDF)
Employer Zip Code Election (PDF)
Benefits, COBRA	top
COBRA Continuation Election (PDF)
Benefits, Supplemental Saving Program	top
Tax Sheltered Annuity Final Settlement Deductions (PDF)
US Saving Bonds Purchase/Payroll Deduction Authorization (PDF)
Benefits, Vision	top
VSP Out-of-Network Reimbursement (PDF)
VSP Video Display Terminal Confirmation (PDF)
Classification and Compensation	top
Classification and Compensation Position Review Request Form (PDF)
Position Description Questionnaire (PDF)
Position Description Template (Staff) (PDF)
Request for Salary_Stipend CSUEU (PDF)
Data and Technical	top
Data Request (PDF)
Discrimination	top
Discrimination 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)
Family Care Medical Leave	top
Employee Medical Certification (PDF)
Family Medical Certification (PDF)
Leave 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)
Leave Programs	top
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 Request Form (PDF)
Request for Catastrophic Leave Donations (PDF)
Request to Participate in the Catastrophic Leave Donation Program (PDF)

ALL STAFF FORMS
Parking	top
Pre-Tax Parking Deduction Election Authorization (PDF)
Payroll	top
Absence and Additional Time Worked Report (PDF)
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)
Request for Salary Advance (PDF)
Request for Substitute Faculty Payment (PDF)
Special Consultant Payment (PDF)
Performance Review	top
CSUEU Staff Performance Review (.xls)
CSUEU Staff Pre-Performance Review Worksheet (PDF)
CSUEU Staff Probationary Performance Review (.xls)
Evaluator Letter for Staff Pre-Performance Review Input Template (PDF)
Report of Employee Performance Unit 4 Academic Support (PDF)
Staff Performance Review Units 1,6,8 (.xls)
Staff Performance Review Guidelines for Writing Effective Goals Worksheet (PDF)
Staff Position Description Template (PDF)
Staff Pre-Performance Review Worksheet Units 1,6,8 (PDF)
Temporary Support Performance Evaluation (PDF)
Unit 4 Academic Professionals of California Staff Plan (PDF)
Recruitment	top
Request for Temporary Support (PDF)
Special Events	top
Special Event Report of Injury or Loss (PDF)
Special Events Liability Insurance Request (PDF)
Special Events Release Agreement (PDF)
Travel	top
Student Accident Report (PDF)
Student Conduct Agreement (PDF)
Student Travel Informed Consent (PDF)
University Activity Release Agreement Guidelines (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
Volunteer Appointment (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

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San Jose State University : Human Resources

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