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Human Resources Forms

Please make sure you have the most recent version of your form.  Do not save them to your Desktop.     

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Absence ReportUsed internally by campus departments to report leave usage.  |  PA-634 (5/2017)Payroll
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: Elbi Magana. | (6/2017)

Employee Relations

Accounts Receivable Signature Authorization Form

This form is used to authorize Payroll Services to establish a retroactive benefits premium/deduction.


Action Request Form- State

This form is used for changes only. Appointment transactions are done through Recruiting Solutions on the portal. | OHRS-20-66T (7/2014)

Employee Relations

Action Request Form-AuxiliaryThis form replaces the Waiver of Recruitment & Appointment Requisition Form - Auxiliary. | OHRS 20-66 AUX (5/2011)

Employee Relations

Applicant Interview Evaluation RecordUsed to evaluate candidates interviewed during a search. |  OHRS-20-54 6/2017)Recruitment
Applicant Screening RecordUsed for screening and rating applications. | OHRS-20-55 AUX (6/2017)Recruitment 
Applicant Selection & Disposition Form -AuxiliaryUsed to convey final selection after completion of interviews in a search. | OHRS-205 AUX (5/2011) Recruitment
Authorization for Moving & Relocation Authorizes reimbursement for moving expenses. | OHRS-20-58 (1/2018)Employee Relations
Authorization to use Privately-Owned Vehicles on State BusinessIn accordance with State Policy (S.A.M. 0753 & 0754)approval is requested to use privately owned vehicles to conduct official State business.  (STD 261 - 3/1995)
Authorization for Extra Hours WorkedUsed internally by campus departments to report overtime, straight time, and C.T.O. to their department timekeeper.Payroll
Benefits Enrollment Worksheet This form has been replaced with the online Benefits Enrollment procedure. For more information on how to enroll, visit:
Campus Timesheet   Used by Student Assistant, Work-Study, and Hourly employees to track their hours worked. | PA-100 (01/2018)Payroll
Catastrophic Leave Pledge FormDonations of sick or vacation leave to employees of CSUN who are eligible for catastrophic leave. | OHRS-1-8 (2/2011) Benefits
Classification AppealUsed for Employee notice of classification appeal. | OHRS 10-2 (11/2004)Classification & Compensation
Certification of Health Care Provider - for Family MemberUsed to support a request for CSU FML leave due to a family members serious health condition. Benefits
Certification of Health Care Provider – for SelfUsed to support a request for CSU FML leave due to one's own serious health condition.Benefits
CSU Flexible Spending Plan (FSA) Debit Card Request FormApplication request form for Health Benefits "Benny" card. | (9/2012)Benefits
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).  | STD 699 (10/2013)Payroll
eBenefits Self Service Electronic Signature Authorization Form  This form enables you to electronically authorize and submit benefit transactions via the eBenefits Self-Service Module, which may include enrollment(s) and change(s), life event processing, and dependent information.  (Rev 3/2016)Benefits
Employee Action Request (EAR) FormThe 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. | STD 686 (3/2015)Payroll
Employee Confidentiality StatementConfidentiality statement for employee access to university data systems containing personal, academic, or financial information about students, faculty, staff or alumni. | OHRS 50-15 (2008)

Employee Relations

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 (1/2017)Payroll
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 (7/2017)Employee Relations
Employee Transfer Data Form - StateThis form is used to obtain personnel data regarding employees transferring from another CSU or State agency. | STD 612 (6/2001)Employee Relations
Employment ApplicationAll applications are now completed online.N/A
Exit Interview QuestionnaireStaff members are encouraged to complete and submit this form to Human Resources when separating from the university. | (6/2017)Employee Relations
Fee-Waiver Work-Related Enrollment RequestApplication for enrolling in the Benefits Fee-Waiver/tuition Reduction program.Benefits
Flexcash Enrollment AuthorizationEnrollment form for CSU FlexCash Plan Authorization. | (01/2018)Benefits
Health Benefit Plan Enrollment FormCalPERS Health Benefits Enrollment Form | PERS HBD-12 (05/2016)Benefits
In-Range Progression Request FormUsed to request an increase within a salary range for a single classification, or within a sub-range of classification. | OHRS 10-17 (5/2016)

Classification & Compensation

Justification for Initiation of Search for Certain Personnel Appointments and/or 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 (8/2017)Recruitment
Leave of Absence Request FormThis form is used to request a Leave of Absence or request to return to work from a leave. | (1/2018)Benefits
Master Payroll Certification (MPC) Exception Form Use this form to report monthly master payroll transactions missed during the regular MPC cycle. | MPC (10/2015)Payroll
New Employee Sign-In Form
Used for new employee sign in. | OHRS 20-56 (9/2018)Recruitment
New Hire Injuries Caused by Work  New Hire Workers' Compensation information for new-hire injuries caused by work.Benefits
Parent Consent FormUse this form when you have a minor as a Volunteer.  The parent/Guardian must fill out this form. (10/2015)

Employee Relations

Parking - Faculty & StaffUsed to obtain a parking permit. The cost of the parking permit is determined by the employee's bargaining unit. | ICS (7/2011)Payroll
Pay Warrant Pick-Up RequestEmployees who want to pick up their warrants on December 31st must complete the Pay Warrant Pick Up Request Form no later than December 14, 2018 and return it to University Cash Services, Bayramian Hall 100R (Mail Drop 8214).  | (10/2018)Payroll
Pay Warrant ReplacementUsed by employees to request a duplicate pay warrant / stop payment (return with Signature to Payroll Administration, University Hall Room 165, questions, call x2101). | STD 435 (10/2014)Payroll
Payroll Designee FormUsed to designate the person(s) entitled to receive all outstanding pay warrants upon the employee´s death. | (10/2018)Payroll
Performance Evaluation Form - MPPUsed to evaluate MPP administrators and supervisors. | (2/2017)

Employee Relations

Performance Evaluation Form - UNIT 4Used to evaluate performances for employees within Unit 4. | OHRS 20-49 (2/2018)

Employee Relations

Performance Review - StaffUsed to evaluate all support staff (instructions included with form). | OHRS 30-11 (2/2018)

Employee Relations

Personnel Action Request (PAR) FormUsed for general personnel action requests for Academic Personnel including Full-Time and Part-Time Faculty, and Academic Student Employees. | (3/2010)Academic Personnel
Personal Physician Pre-Designation FormPre-designation of Personal Physician for Work Related Injury form.  (4/2018) Benefits
Position Description Form - MPPUsed to develop the Performance Program for MPP positions. Formerly the Performance Program - MPP Positions form. OHRS 1-9 (2/2018)

Employee Relations

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 (10/2017) Associated Students and University Student Union.

Employee Relations

Position Description Form - TUCUsed by the University Corporation to provide the employee with a written description of the duties for which he or she is responsible. (4/2005)

Employee Relations

Prior Pay Period Adjustment FormUsed 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. | PA115 (4/2018)Payroll
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)Classification & Compensation
Relocation Declaration of ReimbursementUsed to acknowledge compliance with conditions under which moving and relocation expenses shall be repaid. | OHRS 20-65 (8/2017)Employee Relations
Retirement Application for CalPERSUsed by members of CalPERS to apply for service retirement. | PERS-BSD-369-SBenefits
Selection & Disposition Form - AuxiliaryUsed to convey final selection after completion of interviews in a search. | OHRS 205 AUX (11/2001)Employee Relations
Separation/Clearance FormFor 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 (10/2017)Employee Relations
Signature Authorization Payroll DocumentsUsed by campus departments to notify HRIS/Payroll Administration of persons authorized to sign payroll documents. | OHRS PSC 60 (2/2004)Payroll
SOLAR HR Access Request FormUse this form to request or change access to the HR system for an individual employee. | (6/2013)Benefits

Special Pay Authorization (Excel)

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 (10/2004)Payroll
Special Pay Faculty Pre-Hire ProcessingUsed to initiate job prior to processing special pay authorization (above). | OHRS 50-14 (12/2011)Payroll
This form is provided to employees hired January 1, 2005, or later, in a job not covered by Social Security.  The statement explains how a pension from that job could affect future Social Security benefits to which they may become entitled. Job classifications include student employees.  (5/2005)Benefits
State Driver Accident ReviewInformation form pertaining to a State Vehicle Accident. | STD 274 (1/2003)Benefits
Student Assistant Hire FormUse this form to document the hire of a new Student Assistant. | OHRS 20-60 (3/2013)Employee Relations 
Student Assistant Information FormUse this for for information regarding a new student assistant. | OHRS 30-67 (2/2013)Employee Relations
Student Assistant Payroll SummaryUse this form for Student Payroll.  (8/2005)Payroll
Student Employee Job Data Change FormThis 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)Classification & Compensation
Student Payroll Action Request/Change FormThis 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. | STD 457 (10/2008)Classification & Compensation
Summer YRO Pay AuthorizationUsed by campus departments to request payments for faculty involved in the year-round operations. | PA 110 (8/2005)Payroll
Summer Session 2357 Salary ScheduleUsed by campus departments to report faculty teaching summer only. | PA 135 (6/2006)Payroll
Supervisor Accident/Illness Investigation FormSupervisor form for reporting an accident. | STD 620 (5/2016) | EHSBenefits
Telecommuting Agreement Form    
This agreement establishes the terms and conditions of the Telecommuting Program. The employee volunteers to participate in the Telecommuting Program and to follow the applicable guidelines and policies. CSUN agrees with the employee's participation.
TimesheetUsed by Student Assistant, Work-Study, and Hourly employees to track their hours worked. | PA-100 (01/2018)Payroll
Total Compensation Calculator ToolCalculate your Total CSU Benefits Compensation. | (2/2016)Benefits
Transfer of Leave Balance from Position to Position AuthorizationWhen 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. | OHRS-PSC-60-15 (10/2004) Payroll
Vehicle Accident ReportingReporting an accident involving a vehicle. | STD 270 (2/2002)Benefits
Vehicle Monthly Usage ReportUsed by employees to report mileage of their state or third-party vehicles. | OHRS PSC-60-7 (10/2012)Payroll
Verification of Hourly Employment RequestUsed for Hourly State Employees.  A picture ID must be submitted with this form. | (8/2013)Payroll
Veterans Self-Identification Form    Staff, faculty and auxiliary employees may volunteer to report their veteran status. | OHRS VSID (3/2014)Relations
Vision Out-of-Network Reimbursement FormUse in the event that you see an out-of-network provider for vision services. | (7/2015)Benefits
Vision (Video Display Terminal) Claim FormComputer Eyewear Only | (8/2007)Benefits
Volunteer Identification FormUsed in processing CSUN Volunteer workers.  | OHRS 20-64 (6/2016)  Recruitment
Volunteer Limited Reporter Acknowledgement FormUsed in conjunction with the Volunteer Identification Form and Adjunct Faculty Requisition, this form pertains to the California Child Abuse and Neglect Reporting Act (CANRA) which requires all volunteers/adjunct faculty be identified as Limited Reporters. This form must be signed and submitted to Human Resources. (12/17)Employee Relations
W-2 Duplicate Request
Used to request a duplicate copy of a W-2 for up to 4 prior tax years. Copy of paper form. | STD 436 (9/2006)Payroll
Workers' Compensation Claim Form- DWC 1Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility | (1/2016)Benefits