Human Resources Service Center

Forms, Policies & Procedures

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Forms
TitleDescriptionDepartment
Affordable Care Act (ACA) Health Insurance Marketplace Employee Notice (PDF) Notice for employees regarding their health coverage. To be used if shopping for coverage through Covered California.Benefits
Benefit Enrollment/Change Worksheet (PDF) To enroll or change benefits.Benefits
Computer Vision Glasses Form (PDF) For employees to request a pair of glasses for computer or tablet use while working, should be submitted to vision care provider.Benefits
Orthodontic Continuous Coverage Form (PDF)  For employees who are currently under orthodontic care under another dental plan and are switching to the DeltaCare USA dental plan.Benefits
DCRA/HCRA Manual Claim Form (PDF) To submit your receipts for health and dependent care reimbursement.Benefits
HCRA Debit Card Request Form (PDF) Form to request a Visa debit card for health care expenses.Benefits
TSA Catch-Up Plan Maximum Contribution Worksheet (opens in new window)(Excel)15-year and/or Age 50 Catch-Up.Benefits
The California State University Beneficiary Designation/Change (PDF) For both employer-paid and volunteer beneficiary changes.Benefits
CalPERS Affidavit of Parent/Child Relationship (PDF) To enroll family members in benefits programs if a “parent-child relationship” is established with a child who is not your adopted, step, or recognized natural child and specific criteria is met.Benefits
CalPERS Member Questionnaire for Disabled Dependent Benefit Form (PDF) If you have a disabled dependent, send the completed form to CalPERS. Benefits
CalPERS Medical Report for the Disabled Dependent Benefit Form (PDF) Complete if initial submission for Disabled Dependent Benefit.Benefits
CalPERS Pre-Retirement Lump Sum Beneficiary Designation (PDF) If you are a CalPERS member, use this form to establish or change a beneficiary.Benefits
Classification Review Request Form(opens in new window) (Word)To request a position to be reviewed for a potential classification change.Classification & Compensation
Classification Appeal Form(opens in new window) (Word)To appeal a classification review.Classification & Compensation
IRP - In Range Progression Process and Form(opens in new window) (Box Folder)Process Instructions and Form.Classification & Compensation
Position Description Resources(opens in new window) (Box Folder)
  • Staff and MPP Position Description forms
  • Physical requirements
  • Action verbs
  • Sensitive position grid
  • Working titles guidelines
  • Guidelines for position descriptions
Classification & Compensation
Special Consultant Resources (opens in new window)(Box Folder)Independent contractor vs Employee Worksheet, Special Consultant timesheet and agreement forms.Classification & Compensation
Pay Plan Time-base Conversion Tool(opens in new window) (Excel)Use to calculate time-base or salary changes.Classification & Compensation
Leave of Absence Without Pay Request(opens in new window) (PDF)To request a leave of absence without pay.Employee Leaves & Workers' Compensation
Work Related Injury Forms(opens in new window) (Box Folder)
  • Non-Emergency Transport Request
  • Work Related Injury Report
  • Workplace Injury Illness Information
  • Workers Compensation Claim Form DWC1
  • Notice of Pre-Designation of Personal Physician
Employee Leaves & Workers' Compensation
Employee Action Request (EAR) (PDF) For state employees to use for a name change, address change, or adjust allowances.Employment Services
Employment Eligibility Verification - Form I-9 (paper Version)(opens in new window) (PDF)Paper version of the form I-9.Employment Services
Employment Eligibility Verification - Form I-9 (fillable version)(opens in new window) (PDF)Fillable version of the form I-9.Employment Services
Employment Eligibility Verification - I-9 Instructions(opens in new window) (PDF)Instructions on the form I-9.Employment Services
Live Scan Request Form(opens in new window) (PDF)To request Live Scan services.Employment Services
Moving and Relocation Form and Procedure(opens in new window) (Box Folder) Procedure Outlining and form for Moving and Relocation allocations that exceed $5,000.Employment Services
MPP Position(s) Justification Form(opens in new window) (PDF)Justification form used for MPP actions.Employment Services
Policies Acknowledgement(opens in new window) (PDF)New employee policies acknowledgement.Employment Services
Important Policies, Employment Laws, and Resources(opens in new window) (Web page)Policies for new employees to acknowledge, listed on the Policies Acknowledgement.Employment Services
Notice of Separation (NOS)(opens in new window) (Outlook Template)Notify service centers of employee separating from department or university.Employment Services
Outside Employment Forms and Procedure(opens in new window) (Box Folder)Procedure and form for MPP's to disclose any additional outside of campus employment.Employment Services
Request for Nondisclosure of Employee Home Address (PDF) To request your home address be kept confidential and limit its release to employee agencies by the State Controller's Office.Employment Services
Request to Fill Administrative & Non-Academic Staff Position(opens in new window) (PDF)To request to begin a recruitment.Employment Services
Separation Clearance Process(opens in new window) (Web page)Separation Clearance, Notice of Separation, State Administrative Manual Sections.Employment Services
Staff Action Form(opens in new window) (Excel)To initiate employment actions for staff and MPP's.Employment Services
Mandatory Reporting of Child Abuse and Neglect - General & Limited(opens in new window) (PDF)Limited and General Mandated Reporter form for designated positions.Equal Opportunity and Dispute Resolution
Due Process Rights for CSU, Chico Employees designated as Confidential(opens in new window) (PDF)Description of Due Process Rights for confidential employees.General Human Resources Forms, Procedures and Processes
Reconsideration Procedures for Management Personnel Plan Employees(opens in new window) (PDF)Description of reconsideration procedures for Management Personnel Plan (MPP) employees.General Human Resources Forms, Procedures and Processes
Volunteer Form and Guidelines(opens in new window) (Box Folder)Form and process to become a CSU, Chico volunteer.General Human Resources Forms, Procedures and Processes
Denial of Release Time Request(opens in new window) (PDF)Used for Denial of Release Time Request.Labor Relations
Nepotism Information(opens in new window) (Box Folder)Nepotism agreement form, procedures and agreement tracking.Labor Relations
Summer Hardship Form and Process(opens in new window) (Box Folder)Instructions and form to be completed if an employee needs to work an alternate summer work schedule.Labor Relations
Absence and Additional Time Report- "Absence Report and Intermittent Employee Timesheet STD 634"(opens in new window) (Box Folder)Absence report timesheet and information.Payroll
Academic Pay Plans(opens in new window) (PDF)Reflects pay schedules for AY employees.Payroll
Attendance Certification - Master Payroll(opens in new window) (PDF)Master Payroll certification overview.Payroll
Attendance Summary (STD640) (PDF)Employee Attendance Summary State Pay Period Calendar Year.Payroll
CTO Payoff Process for Non-Exempt to Exempt Employee Moves(opens in new window) (PDF)Details effect of transition to exempt classification on CTO balance.Payroll
Direct Deposit Enrollment Authorization (PDF)Request direct deposit enrollment for state employees.Payroll
Net Pay Calculator(opens in new window) (Excel)Calculate net pay and withholding amounts.Payroll
Overtime Authorization Form(opens in new window) (PDF)Request & report overtime for non-exempt employees.Payroll
Procedures for Student Assistants and Work Study Employees(opens in new window) (PDF)Basic procedures for student employees.Payroll
Request for Final Payment (Academic Year Employees)(opens in new window) (PDF)Request early final pay for AY employee & request SRP deduction from settlementPayroll
Shift Differential and Special Pay Form(opens in new window) (PDF)Report shift differential and special pay.Payroll
Signatory Responsibilities and Form Information(opens in new window) (Box Folder)Form and instructions on how to complete the Signatory Authorization Form.Payroll
Student Payroll Forms(opens in new window) (Box Folder)
  • Bridge Student Appointment
  • SEA - Student Employment Authorization
  • PT-11 Transfer of Funds
  • Position Request Number for Student Employee
Payroll
Student Employee Process Guides(opens in new window) (Box Folder)
  • Student Time & Labor
  • Enter Student Time
  • Review Time
  • Manage Exceptions
  • Approve Payable Time
  • Job Roster Report
  • Student Employee Data Lookup
  • Student Employee Reports to Maintainer Guide
  • Student GA, TA, ISA Report
  • Student Pay Report
  • Separation Report
Payroll
Substitute Appointment Forms and Timesheet(opens in new window) (Box Folder)
  • Substitute Appointment Form Faculty
  • Substitute Appointment Timesheet Faculty
  • Substitute Appointment Form TA
  • Substitute Appointment Timesheet TA
Payroll
Vacation Carry-over Form(opens in new window) (PDF)Request to Carry-Over More than Allowable Vacation Credits.Payroll
Work Schedule Information - Notice of Work Schedule & Guidelines(opens in new window) (Box Folder)
  • Notice of Work Schedule 1 week
  • Notice of Work Schedule 2 week
  • Work Schedule Guidelines
Payroll
W-2 Duplicate Form (PDF)Form to request duplicate W-2.Payroll
Wireless Device Allowance Form and Procedures(opens in new window) (Box Folder)Instructions and form to initiate/cancel a wireless device allowance.Payroll
Staff Performance Evaluations Short & Long Forms(opens in new window) (Box Folder)Performance evaluation form for staff in all units, including C99 - long form; for confidential support, operational support, technical support, skilled crafts, public safety, and professional staff. Long or Short form can be used for CSUEU Staff. Word version of short form also available.Performance Management
MPP Performance Evaluation(opens in new window) (PDF)Performance evaluation form for managers and administrators.Performance Management
Unit 4 Academic Support Performance Evaluation(opens in new window) (PDF)Performance evaluation form for staff in Unit 4.Performance Management
Unit 8 UPD Performance Evaluation(opens in new window) (PDF)Performance evaluation form for staff in Unit 8.Performance Management
Fee Waiver Forms(opens in new window) (Box Folder)
  • Fee Waiver Application for Employees
  • Fee Waiver Application for Dependents
  • Faculty and Staff Career Development Plan
  • Job Related Undergraduate Admissions Application
  • Job Related Graduate Admissions Application
Professional Development
Conflict of Interest (COI) Prevention (Web page)
  • Designated Positions
  • CSU Disclosure Categories
  • Form 700, Statement of Economic Interests
  • Link to CSU Specific COI Training
Professional Development
Form 700 Introduction (Web page)
  • Form 700
  • Form 700 Cover page
Professional Development
Gifts to Agency (Web page)
  • CSU HR Memo
  • CSU Conflict of Interest Handbook
  • FPPC Form 803
  • FPPC Form 802
Professional Development
Additional Employment Policy HR 2002-05 (PDF)Policy establishing reasonable limits on the total amount of employment an individual may have within the CSU system.Policies
Discrimination, Harassment and Retaliation Policy EM 12-043 (PDF)Policy on Systemwide required background checks.Policies
Discrimination, Harassment and Retaliation Policy EM 12-043 (Web page)Policy on Discrimination, Harassment and Retaliation.Policies
Policy of Campus Behavior and Violence Prevention EM 12-025  (Web page)Policy campus behavior and violence prevention.Policies
Smoking Policy EO 1108(opens in new window) (Web page) Policy on the Systemwide Smoke and Tobacco Free Environment.Policies