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)
Affidavit of Parent-Child Relationship
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)
Classification and Compensation	top
Classification and Compensation Position Review Request Form (PDF)
Position Description Questionnaire (PDF)
Contact your Workforce Planning team to request a Staff Position Description Template
Salary_Stipend Request for CSUEU (PDF)
Data and Technical	top
Data Request (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 Instructions, Guideline and Form(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 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)
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)
Leave of Absence Request Form (PDF)
Leave Without Pay Request Form (PDF)

ALL STAFF FORMS
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)
Excess Vacation Accrual Carry-Over Request (PDF)
Hourly Time Sheet (.xls)
Reporting Informal Leave without Pay (Docks) (PDF)
Salary Advance Request (PDF)
Special Consultant Payment (PDF)
Substitute Faculty Payment Request (PDF)
Performance Review	top
CSUEU Annual Performance Review (.xls)
CSUEU Staff Pre-Performance Review Worksheet (PDF)
CSUEU Probationary Performance Review (.xls)
Report of Employee Performance Unit 4 Academic Support (PDF)
Staff Performance Review Units 1 and 8 (.xls)
Staff Performance Review Guidelines for Writing Effective Goals Worksheet (PDF)
Contact your Workforce Planning team to request a Staff Position Description Template
Staff Pre-Performance Review Worksheet Units 1, 4, 8 (PDF)
Recruitment	top
Temporary Support Request (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
Release of Liability Form (PDF)
Student Accident Report (PDF)
Student Conduct Agreement (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
Volunteer Request and Appointment Package (PDF)
Worker's Compensation	top
Employers Report of Occupational Injury or Illness (PDF)
Occupational Injury or Illness Checklist (PDF)
Notice of Personal Chiropractor or Acupuncturist (PDF)
Notice of Pre-designation of Personal Physician (PDF)
Workers' Compensation Facts for New Employees (PDF)
Workers Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (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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