Human Resources, Safety & Risk Management

Furlough | Benefits | Employment | Financial & Retirement | Online Resources | Payroll | Professional Development | Risk | Temporary lecturer/Faculty

Furlough
Form #	Form Title/ Description	WORD	PDF	WEB
	FURLOUGH AGREEMENT Form instructions
	All administrators, staff and 12 month faculty subject to the furlough are required to complete and submit the FURLOUGH AGREEMENT FOR ADMINISTRATORS, STAFF & 12 MONTH FACULTY to Human Resources by August 26, 2009 in accordance with the attendance reporting process. Employees returning from leave or newly hired should complete the form by the first attendance reporting cycle.
	FURLOUGH - ADDITIONAL TIME WORKED REPORT (STD 634) Form Instructions
	The ABSENCE AND ADDITIONAL TIME WORKED REPORT (STD 634) has been revised to include a code “F” for furlough day. Form 634 must be submitted to Human Resources on a monthly basis and reflect the furlough days taken for that month as well as any vacation, sick leave or cto taken. (Rev Aug 2009)

Benefits
Form #	Form Title/ Description	WORD	PDF	WEB
	Affidavit of Marriage In lieu of a marriage certificate required to enroll spouse into benefit plans.
	Affidavit of Eligibility for Economically Dependent Children The needed form to add an economically dependent child or children to your health plan.
	CalPERS Beneficiary Designation Form
	COBRA Election Form
	COBRA Rates 2009
	Declaration of Domestic Partnership To register domestic partnership with the State of California.
	Declaration of Health Coverage - HBD12A
	Dental Plan Enrollment Authorization To enroll in the dental plan.
	Employer Zip Code Selection To qualify for HMO based on employer zip code instead of residential zip.
	Flexcash Program Enrollment Authorization To enroll in the Flexcash Program.
	HCRA/DCRA Enrollment Authorization To enroll in the Flexcash Program.
	HCRA/DCRA Combined Claim Form Claim form to be used with Dependent Care/ Health Care Reimbursement Account Plans
	Medical Plan Comparison Chart
	Paid Maternity/Paternity/Adoption/Parental Leave Request Form
	PERS Health Benefit Plan Enrollment Form To enroll in a Health Benefit Plan.
	Pre-Tax Parking Deduction Election Authorization To enroll or cancel pre-tax parking program.
	The Standard Employer Paid Life and AD&D Beneficiary Designation Form
	VSP Out-of-Network Reimbursement Form To claim expenses for out-of-network vision services.
	VSP Video Display Terminal(VDT) Claim Form To claim VDT glasses.
	Catastrophic Leave Donation Form Used to submit donations of sick or vacation leave to employees who are eligible for catastrophic leave.
	Family Care and Medical Leave Certification Used by employee's or employee family member's health care provider to certify medical condition.
	Leave of Absence Request (Faculty Only) Employee report for medical leave without pay
	Extension of Probationary Period form (Faculty Only) Used with Faculty Leave of Absence
	Leave of Absence Without Pay, Request form For staff and administrative personnel.

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Employment
Form #	Form Title/ Description	WORD	PDF	WEB
	Application for Staff/Administrator (Non-Faculty) To apply for a staff/administrator position at SFSU.
	Conditions of Employment Applies to all staff and administrative employees of San Francisco State University .
	Designee Form Designation of person authorized to receive warrants.
	Form I-9, Employment Eligibility Verification Employment information and verification.
	Form I-9, Instructions Employment information and verification.
	Oath of Allegiance Oath of allegiance and declaration of permission to work for persons employed by the State of California.
	Position Description for Staff Describe the duties, responsibilities and qualifications of the position.
	Position Description for Administrator (MPP) Describe the duties, responsibilities and qualifications of the position.
	Recruitment Authorization Use this form to obtain authorization to recruit for a position.
	Recruitment Minimum Qualifications Examples Sample Minimum Qualifications text.
	Special Consultant To appoint a special consultant.
	Staff Recommendation To recommend a candidate for hire.
	Telecommuting Agreement To be completed annually by those enrolled in the program.
	Unit 4 Merit Bonus Recommendation Form An Administrator may request a bonus for Unit 4 eligible employees.
	Volunteer Agreement To acknowledge that services have been volunteered
	Work Schedule To indicate an employee's work schedule.

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Online Resources
Form #	Form Title/ Description	WORD	PDF	WEB
	Clearance Request To make an appointment with the Human Resources Clearance Specialist
	Employee Leave Accounting
	Personnel Practice Directives

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Payroll
Form #	Form Title/ Description	WORD	PDF	WEB
	Absence and Additional Time Worked Report To report employee absences or additional time worked. (Rev Aug 2009)
	Absence and Additional Time Worked Report Instructions Instructions on how to complete the February 2006 revised Absence and Additional Time Worked Report.
	Authorization for Extra Hours Form required to authorize request to work overtime.
	Direct Deposit Enrollment Authorization To enroll in direct deposit of paychecks.
	Dock Notice To notify Payroll that an employee is being docked.
	Employee Action Request To report changes of address and withholding allowance.
	Honorarium Payment Request To request payment for presenter/lecturer at a campus event.
	Information About Social Security Form Statement concerning employment in a job not covered by Social Security
	Leave Discrepancies Reporting Form Use this form to report discrepancies in your leave statement
	Report of Extra Hours Worked Form required to record extra hours worked.
	Request for Duplicate W-2 To request duplicate W-2
	Savings Bond Authorization To purchase or change savings bond by payroll deduction.
	Student Payroll Action Request To obtain pertinent information for student employees, address changes, and withholding allowance.
	Substitute Faculty Appointment To appoint substitute faculty.
	Warrant Designee To designate individual to receive final pay.

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Financial & Retirement
Form #	Form Title/ Description	WORD	PDF	WEB
	Initiating Retirement at San Francisco State
	CalPERS Beneficiary Designation (active employees only)
	CalPERS Service Credit Purchase Options
	CalPERS Service Retirement Election Application
	CalPERS Disability Retirement Election Application
	CalPERS Retirement Allowance Estimate Request
	Maximum Exclusion Allowance 403(b) Request Form
	Savings Plus Program Rehired Annuitant Enrollment Booklet
	PST Benefit Payment Booklet

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Professional Development
Form #	Form Title/ Description	WORD	PDF	WEB
	Employee Fee Waiver Application
	Employee Fee Waiver Change of Course(s) Form
	Dependent Fee Waiver Application
	Performance Evaluation Form
	Unit 4 Performance Evaluation Form
	Management Personnel Plan Performance Review
	Individual Career Development Plan (ICDP) - Form

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Risk Management
Form #	Form Title/ Description	WORD	PDF	WEB
	Request for Foreign Travel Insurance Packet
	Release of Liability Packet
	SFSU - FTIP Coverage Summary

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Temporary Lecturer/Faculty
Form #	Form Title/ Description	WORD	PDF	WEB
FAO 112	Application for Temporary Faculty Employment
FAO 113	Application for Subsequent Temporary Faculty Appointment
FAO 114	Temporary Faculty Evaluation Form

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