HR Forms & Procedures
Benefits
- eBenefits Self-Service Authorization form
Employee authorization form to enroll or modify benefits enrollment.
- Benefits - CalPERS Affidavit of Marriage
Allows certification of marriage when no marriage certificate is available.
- Blue Shield Access + (HMO) and Net Value (HMO): Selecting Primary Care Physician
Form needs to be mailed to Blue Shield (HMO) with current or newly selected Blue Shield (HMO) physician(s) and medical group(s).
- Blue Shield Access+ and Net Value: Changing Primary Care Physician
Step-by-Step guide on how to change primary care physician.
- Catastrophic Leave Donation Request and Certification Form
Employee request for participation.
- Delta Dental Claim Form
For employees to be able to submit dental claims.
- Domestic Partnership Imputed Tax Notice
- Domestic Partnership Imputed Tax Notice
- FML - Family and Medical Leave Act
Summary of the Family and Medical Leave Act program.
- FML - Health Care Provider's Certification for Family Medical Leave
Certification of employee's request for family medical leave to self or to care for eligible dependent.
- FML - Family and Medical Leave Notice and Request Form
To process employee request for family medical leave.
- Injury/Illness Report
- Reporting Injuries
How to report injuries/illnesses.
- Supervisor's Injury/Illness Report
For supervisor to report an injury.
Form must be completed by supervisor with employee.
- Employee's Injury/Illness Report
For employee to report an injury.
- Leave of Absence Guide
Guide describing leaves of absence.
- Leave of Absence Request
To request a leave of absence.
- Life - Employer Paid Life Certificate 2005
Certificate for group life insurance.
- LTD - Employer Paid Certificate 2005
Certificate for group long term disability insurance.
- Return-to-Work
- Transitional Plan
- Work Activity Analysis
- Work Activity Analysis (Sample)
- Employee Information Sheet
Forms to be completed by supervisor for work related
or non-work related transitional work due to work restrictions.
- The Standard Life Insurance
Beneficiary form
- TSA - 2011 Automated Tax Sheltered Annuity 15 year Catch-up Calculation Worksheet
To demonstrate eligibility for 15 year catch up contributions for TSA 403(b).
- TSA - Tax Sheltered Annuity Companies
List of TSA (403b) plans.
- Vision - Out-of-Network Reimbursement Form
To claim vision services with an out-of-network provider.
- Vision - Video Display Terminal (VDT) Claim Form
To claim VDT glasses.
- WC - Guide for Managers and Supervisors
A guide for managers and supervisors on the Workers' Compensation process and procedures.
- WC - Industrial Disability Plan
To process application for industrial disability benefits.
- WC - Employee's Description of Job Duties (DWC RU-91)
To describe job duties. Completed by Supervisor and Employee.
- WC - Employee's Description of Job Duties (DWC RU-91) Instructions
Glossary of terms for completing form (DWC RU-91).
- WC - Predesignation of Personal Physician
To designate personal physician in the event of a work related injury/illness.
Classification & Compenstation Forms
- Position Description Form
To describe positions submitted for classification reviews.
- In-Range Salary Progression Guidelines
To request a permanent increase to a base salary within a salary range for a single classification.
- Request for Reclassification Review
To request reviewing of a position and determining an appropriate CSU classification for all staff (non-faculty) positions.
Employment
Perfomance Review Forms
- Employee Self Appraisal Form
For employee to fill in prior to evaluation.
- Performance Review Guide
PowerPoint slides
- MPP Performance Review Form
To evaluate MPP's performance.
- Staff Performance Review Form
To evaluate staff employees' performance (except Unit 3 and 4).
- Unit 4 Staff Performance Review Form
To evaluate Unit 4 employees' performance.
Personnel Services
- Separating Employee Clearance Form
To process the resignation or retirement of employee.
- Volunteer Appointment Form
To appoint and process CSUEB volunteers.
Recruitment Forms
- Template - Application Screening Grid
To log scores during application screening (one per each selection committee member)
- Template - Application Screening Summary
To total all scores of application screening
- Template - Interview Rating Sheet
To note candidates answers and scores during interview
- Template - Interview Results Summary
To log and total interview scores.
