HR

Human Resources Forms

Human Resources Forms

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FORMS

DESCRIPTION

NAME

ABSENCE REPORT

Used internally by campus departments to report leave usage.

PA-634 (10/2011)

ACCESS PERSONNEL FILE FORM 

For employees wishing to view their personnel files. The completed form should be return to HR/mail drop 8229 or faxed to (818) 677- 7200, Attn: Cindy Mitchell.

(04/2009)

ACTION REQUEST FORM - STATE

This form is used for changes only. Appointment transactions are done through Recruiting Solutions on the portal. For instructions and quick-guides on using Recruiting Solutions, please visit the Jobs@CSUN website.

OHRS-20-66 ST (11/2010)

ACTION REQUEST FORM-AUXILIARY

This form replaces the Waiver of Recruitment & Appointment Requisition Form - Auxiliary.

OHRS   20-66 AUX (5/2011)

APPLICANT INTERVIEW EVALUATION RECORD

 Used to evaluate candidates interviewed during a search.

OHRS-20-54 (7/2014)

APPLICATION SCREENING RECORD

 Used for screening and rating applications.

OHRS-20-55 (7/2014)

APPLICANT SELECTION & DISPOSITION FORM-AUXILIARY

 Used to convey final selection after completion of interviews in a search.

OHRS-205 AUX (5/2011)

AUTHORIZATION FOR MOVING & RELOCATION

 Authorizes reimbursement for moving expenses.

OHRS-20-58 (3/2007)

AUTHORIZATION TO USE PRIVATELY-OWNED VEHICLES ON STATE BUSINESS (STD 261)

In accordance with State Policy (S.A.M. 0753 & 0754)approval is requested to use privately owned vehicles to conduct official State business.

 

BENEFITS ENROLLMENT WORKSHEET

The Benefits Enrollment Worksheet is used by new employees at Sign-In or by current employees to indicate changes to Benefit Plans at qualifying times.

(1/2013)

CalPERS HEALTH BENEFIT PLAN ENROLLMENT FORM

Enrollment Authorization form for CalPERS Health Benefit Plan.

 

CAMPUS TIMESHEET

Used by Student Assistant, Work-Study, and Hourly employees to track their hours worked.

PA-100 (11/2011)

CATASTROPHIC LEAVE DONATION FORM

Donations of sick or vacation leave to employees of CSUN who are eligible for catastrophic leave.

OHRS 1-8 (2/2011)

CATASTROPHIC LEAVE DONATION PROGRAM

Used to request participation in the Catastrophic Leave donation Program.

OHRS-3079 (4/2004)

CLASSIFICATION APPEAL

Used for Employee notice of classification appeal.

OHRS 10-2 (11/2004)

CSU FLEXIBLE SPENDING PLAN (FSA) DEBIT CARD REQUEST FORM

Application request form for Health Benefits "Benny" card.

 

DENTAL PLAN ENROLLMENT AUTHORIZATION

Dental Plan enrollment form.

 

Direct Deposit - Complete BOTH forms:

1. DIRECT DEPOSIT ENROLLMENT AUTHORIZATION

Used to enroll in or change direct deposit of pay warrants (return with signature to Payroll Administration, University Hall Room 165; questions, call x2101).

Please fill in the Direct Deposit Contract below as well.  Complete both forms.

STD 699 (10/2013)

2. DIRECT DEPOSIT CONTRACT 

Used to enroll in or change direct deposit of pay warrants (return with signature to Payroll Administration, University Hall Room 165; questions, call x2101).

STD 699 (10/2013)

EMPLOYEE ACTION REQUEST (EAR) FORM

The Employee Action Request Form is used to make changes to Federal and State Withholding and/or address changes for Faculty, Staff, and Administrators only. Remit completed form to Payroll Administration, UN-165 with original signature and date. No photocopies accepted. Link to form takes you to a State of California form. 

STD 686 (7/2007)

EMPLOYEE CONFIDENTIALITY STATEMENT

Confidentiality statement for employee access to university data systems containing personal, academic, or financial information about students, faculty, staff or alumni.

 OHRS 50-15 (2008)

EMPLOYMENT ELIGIBILITY VERIFICATION I-9

All U.S. employers must ensure proper completion of Form I-9 for each individual they hire for employment in the United States

 

EMPLOYEE INFORMATION FORM (EIF) - STATE & AUXILIARY EMPLOYEE

The Employee Information Form is completed by all State & Auxiliary Employees at Sign-In. The EIF provides the University with contact, education, payroll designee and emergency contact information. The EIF also contains the "Oath of Allegiance." The EIF is also used to advise the University of changes in contact information (address, telephone number, etc). Instructions are included with this form.

OHRS 30-72 (3/2011)

EMPLOYEE TRANSFER DATA FORM-STATE

This form is used to obtain personnel data regarding employees transferring from another CSU or State agency.

STD 612 (6/2001)

EMPLOYMENT APPLICATION

All applications are now completed online.

 

EXIT INTERVIEW QUESTIONNAIRE

Staff members are encouraged to complete and submit this form to Human Resources when separating from the university.

(4/2008)

EXTRA HOURS WORKED AUTHORIZATION

Used by campus employees to document their overtime, CTO, or straight time worked in excess of their regular schedule.

PA 125 (4/2004)

EXTRA HOURS WORKED, CONTROL LOG, CTO

Monthly control log used to summarize all of the CTO (Compensatory Time Off) credits earned by employees. Must be submitted with "Authorization for Extra Hours Worked" sheet(s).   INSTRUCTIONS FOR THIS FORM

OHRS PSC 60-66 (8/2005)

EXTRA HOURS WORKED, CONTROL LOG, STRAIGHT TIME

Monthly control log used to summarize all of the overtime/straight time cash payments due to employees. Must be submitted with "Authorization for Extra Hours Worked" sheet(s)

OHRS PSC 60-5 (8/2005)

FAIR EMPLOYMENT & HOUSING COMMISSION CERTIFICATION OF HEALTH CARE PROVIDER

California Family Rights Act of 1993 (CFRA)<a id="F" class="mceItemAnchor"></a>

 

FEE-WAIVER WORK RELATED ENROLLMENT REQUEST

Application for enrolling in the Benefits Fee-Waiver/tuition Reduction program.

 

FLEXCASH ENROLLMENT AUTHORIZATION

Enrollment form for CSU FlexCash Plan Authorization.

 

HCRA/DCRA ENROLLMENT AUTHORIZATION

CSU Dependent Care / Health Care Reimbursement Acount Plans Enrollment Authorization

 

HEALTH BENEFIT PLAN ENROLLMENT FORM

CalPERS Health Benefits Enrollment Form

 

IN-RANGE PROGRESSION REQUEST FORM 

Used to request an increase within a salary range for a single classification, or within a sub-range of classification.

OHR 10-17 (03/2011)

JUSTIFICATION FOR INITIATION OF SEARCH FOR CERTAIN PERSONNEL APPOINTMENTS/ACTIONS IN THE GENERAL FUND FOR ACADEMIC AFFAIRS

This form is to be completed and attached to the Personnel Requisition for all requests to initiate a search for management, probationary, and temporary renewable staff appointments; and extensions of temporary renewable appointments of six months or more in the General Fund for Academic Affairs.

OHRS 20-62 (01/2004)

LEAVE OF ABSENCE REQUEST FORM

This form is used to request a Leave of Absence or request to return to work from a leave.

(01/2013)

LEAVE OF ABSENCE REQUEST WORKSHEET 

Employee Request for Leave of Absence Worksheet (To be submitted with Medical Certification.

 

LEAVE OF ABSENCE PHYSICIAN VERIFICATION

Physician Verification for Leave of Absence

 

MASTER PAYROLL CERTIFICATION (MPC) EXCEPTION FORM

Use this form to report monthly master payroll transactions missed during the regular MPC cycle.

MPC Form (1/2006) 

NEW EMPLOYEE SIGN-IN FORM

Used for new employee sign in.

OHRS 20-56 (10/2013) 

PARKING-FACULTY & STAFF

Used to obtain a parking permit. The cost of the parking permit is determined by the employee's bargaining unit.

UCS (7/2011)

PAY WARRANT PICK-UP REQUEST

Employees who want to pick up their warrants on December 31st must complete the Pay Warrant Pick Up Request Form no later than December 17, 2014 and return it to University Cash Services, Bayramian Hall 100R (Mail Drop 8214). 

(10/2014) 

PAY WARRANT REPLACEMENT

Used by employees to request a duplicate pay warrant / stop payment (return with Signature to Payroll Administration, University Hall Room 165, questions, call x2101). Link to form takes you to State of California forms website.

PAYROLL DESIGNEE FORM

Used to designate the person(s) entitled to receive all outstanding pay warrants upon the employee´s death.

STD 243 (11/2013) 

PERFORMANCE EVALUATION FORM - MPP

 Used to evaluate MPP administrators and supervisors.

(7/2007)

PERFORMANCE EVALUATION FORM - UNIT 4

 Used to evaluate performances for employees within Unit 4.

OHRS 20-49 (12/2005)

PERFORMANCE REVIEW - STAFF

 Used to evaluate all support staff (instructions included with form).

OHRS 30-11 (8/2002)

PERSONNEL ACTION REQUEST (PAR) FORM

Used for general personnel action requests for Academic Personnel including Full-Time and Part-Time Faculty, and Academic Student Employees.

(3/2010)

PERSONAL PHYSICIAN PRE-DESIGNATION FORM

Designation of personal physician.

POSITION DESCRIPTION FORM (MPP)

Used to develop the Performance Program for MPP positions. Formerly the Performance Program - MPP Positions form.

POSITION DESCRIPTION FORM (STAFF) 

Used to provide the employee with a written description of the duties for which he or she is responsible. This form is used by the University, OHRS 10-09 (11/2004)Associated Students and University Student Union.

POSITION DESCRIPTION FORM (TUC)

Used by the University Corporation to provide the employee with a written description of the duties for which he or she is responsible.

PRIOR PAY PERIOD ADJUSTMENT FORM

Used by campus departments to request adjustments to an employee's pay and/or leave balance, including sick leave, CTO, and vacation usage from a prior pay period.
Do not use this form for Work-Study prior pay period adjustments - use the next form below. 

PA 115 (8/2005)

PRIOR PAY PERIOD ADJUSTMENT FORM (FEDERAL WORK STUDY)

Summary to report miscellaneous adjustments to Work-Study Payroll, including hours from a prior pay period. Use for on and off campus Work-Study. (Instructions included with form.)

OHRS C-80-10 (2/2011)

RELOCATION DECLARATION OF REIMBURSEMENT

Used to acknowledge compliance with conditions under which moving and relocation expenses shall be repaid.

OHRS 2065 (3/2005) 

RETIREMENT APPLICATION FOR CALPERS

Used by members of CalPERS to apply for service retirement.

PERS-BSD-369-S 

SELECTION & DISPOSITION FORM-AUXILIARY

 Used to convey final selection after completion of interviews in a search.

OHRS 205 AUX (9/2009)

SEPARATION/CLEARANCE FORM

For all faculty and staff who are separating employment from CSUN. Full and part-time faculty members who are expected to return during the following semester may be exempt from this process, at the discretion of the Dean of the College.

OHRS 30-23 (7/2014) 

SEPARATION/CLEARANCE DESIGNEE ELECTION FORM

Designee Election form for Separation/Clearance.

 

SIGNATURE AUTHORIZATION PAYROLL DOCUMENTS

Used by campus departments to notify HRIS/Payroll Administration of persons authorized to sign payroll documents.

OHRS PSC 60-16 (2/2004)

SOLAR HR ACCESS REQUEST FORM

Use this form to request or change access to the HR system for an individual employee.

(6/2013) 

SPECIAL PAY AUTHORIZATION (XLS)

SPECIAL PAY AUTHORIZATION (HTML)

Used by campus departments to request payments for hours, units, or days worked on projects falling under the "Special Pay" classifications. INSTRUCTION FOR THIS FORM

PA 120 (3/2005)

SPECIAL PAY FACULTY PRE-HIRE PROCESSING

Used to initiate job prior to processing special pay authorization (above).

OHRS 50-14 (12/2008)

STATE DRIVER ACCIDENT REVIEW (STD 274)

Information form pertaining to a State Vehicle Accident.

 

STUDENT ASSISTANT HIRE FORM

Use this form to document the hire of a new Student Assistant.

OHRS 20-60 (10/2001)

STUDENT ASSISTANT PAYROLL SUMMARY

Use this form for Student Payroll.

 

STUDENT EMPLOYEE JOB DATA CHANGE FORM

This form is used to document and authorize requests for additional appointment or change to the current employment status of a student assistant or work-study student.

OHRS 20-57 (2/2013)

STUDENT PAYROLL ACTION REQUEST/CHANGE FORM

This form is used to document and authorize requests for additional appointment or change to the current employment status of a student assistant or work-study student.

 

SUMMER YRO PAY, AUTHORIZATION

Used by campus departments to request payments for faculty involved in the year-round operations.

PA 110 (8/2005)

SUMMER SESSION 1/30th PAY RATE

Used by campus departments to report summer session pay for faculty that has worked the previous fall or spring.

PA 130 (6/2005)

SUMMER SESSION 2357 SALARY SCHEDULE

Used by campus departments to report faculty teaching summer only.

PA 135 (6/2005)

SUPERVISOR ACCIDENT/ILLNESS INVESTIGATION FORM

Supervisor form for reporting an accident.

 

TIMESHEET

Used by Student Assistant, Work-Study, and Hourly employees to track their hours worked.

PA-100 (11/2011)

TOTAL COMPENSATION CALCULATOR TOOL

Calculate your Total CSU Benefits Compensation.

 

TRANSFER OF LEAVE BALANCE FROM POSITION TO POSITION, AUTHORIZATION

When an employee has multiple positions and is earning vacation or sick leave in more than one job, the employee may transfer hours between positions. This transfer is allowed when there is an insufficient balance in the second position and the employee needs a specific amount to cover a time off for a specific time period.

 (7/2002)

VEHICLE ACCIDENT REPORTING

Reporting an accident involving a vehicle.

 

VEHICLE ACCIDENT REPORT FORM (STD 270)

Reporting an accident involving a vehicle.

 

VEHICLE MONTHLY USAGE REPORT

Used by employees to report mileage of their state or third-party vehicles.

OHRS-PSC-60-7 (10/2004)

VERIFICATION OF HOURLY EMPLOYMENT REQUEST

Used for Hourly State Employees.  A picture ID must be submitted with this form.

 

VETERANS SELF-IDENTIFICATION FORM

Staff, faculty and auxiliary employees may volunteer to report their veteran status.

OHRS-VSID (8/2009)

VISION OUT-OF-NETWORK REIMBURSEMENT FORM

Use in the event that you see an out-of-network provider for vision services. 

(1/2007)

VISION (VIDEO DISPLAY TERMINAL CLAIM FORM)

Computer Eyewear Only

 

(1/2007)

VOLUNTEER IDENTIFICATION FORM

 Used in processing CSUN Volunteer workers.  

OHRS 20-64 (6/2005)

W-2 DUPLICATE REQUEST

 Used to request a duplicate copy of a W-2 for up to 4 prior tax years.

STD 436 (9/1997)

WORKERS COMPENSATION CLAIM FORM (DWC 1)

Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility