Human Resources, Safety & Risk Management Forms

Benefits |  Classification And Compensation | Employment | Financial & Retirement |  HRMS | Online Resources | Payroll |  Professional Development |  Safety And Risk Management Temporary Lecturer/Faculty 

 

Benefits

Form #
Form Title/ Description
WORD
PDF
WEB
  Open Enrollment 2012      
  CalPERS Health Enrollment Form   Health Benefit PDF Icon    
  Dental Enrollment Form   Dental plan PDF Icon    
  FlexCash Enrollment Form   Flex Cash PDF Icon    
  Flexible Spending Benny Card Summary   Flex Cash PDF Icon    
  Flexible Spending Plan (FSA) Request Form   Flex Cash PDF Icon    
  HCRA Debit Card FAQ   Flex Cash PDF Icon    
  HCRA/DCRA Election Form   DCRA HCRA PDF Icon    
  ______________________________________      
  Affidavit of Marriage In lieu of a marriage certificate required to enroll spouse into benefit plans.   Affidavit of Marriage PDF Icon  
  Affidavit of Eligibility for Economically Dependent Children The needed form to add an economically dependent child or children to your health plan.   Affidavit of Eligibility for Economically Dependent Children PDF Icon  
  CalPERS Beneficiary Designation Form   CalPERS Beneficiary Designation Form PDF Icon  
  COBRA Election Form    COBRA Election Form PDF Icon  
  COBRA Rates 2010    COBRA Rates 2009 PDF Icon  
  Declaration of Domestic Partnership To register domestic partnership with the State of California.  

Declaration of Domestic Partnership PDF Icon

 
  Declaration of Health Coverage - HBD12A   Declaration of Health Coverage - HBD12A PDF Icon  
  Dental Plan Enrollment Authorization To enroll in the dental plan.   Dental Plan Enrollment Authorization PDF Icon  
  Employer Zip Code Selection To qualify for HMO based on employer zip code instead of residential zip.   Employer Zip Code Selection PDF Icon  
  Flexcash Program Enrollment Authorization To enroll in the Flexcash Program.   Flexcash Program Enrollment Authorization PDF Icon  
  HCRA/DCRA Enrollment Authorization To enroll in the Flexcash Program.   HCRA/DCRA Enrollment Authorization PDF Icon  
  HCRA/DCRA Combined Claim Form Claim form to be used with Dependent Care/ Health Care Reimbursement Account Plans   HCRA/DCRA Combined Claim Form PDF Icon  
  Medical Plan Comparison Chart   Medical Plan Comparison Chart PDF Icon  
  Paid Maternity/Paternity/Adoption/Parental Leave Request Form   Medical Plan Comparison Chart PDF Icon  
  CalPERS Health Benefit Plan Enrollment Form To enroll in a Health Benefit Plan   PERS Health Benefit Plan Enrollment Form PDF Icon  
  Pre-Tax Parking Deduction Election Authorization To enroll or cancel pre-tax parking program.   Pre-Tax Parking Deduction Election Authorization PDF Icon  
  The Standard Employer Paid Life and AD&D Beneficiary Designation Form   The Standard Employer Paid Life and AD&D Beneficiary Designation Form PDF Icon  
  VSP Out-of-Network Reimbursement Form To claim expenses for out-of-network vision services.   VSP Out-of-Network Reimbursement Form PDF Icon  
  VSP Video Display Terminal(VDT) Claim Form To claim VDT glasses.   VSP Video Display Terminal(VDT) Claim Form PDF Icon  
  Catastrophic Leave Donation Form Used to submit donations of sick or vacation leave to employees who are eligible for catastrophic leave. Catastrophic Leave Donation Form Word Icon Catastrophic Leave Donation Form PDF Icon  
  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 Leave of Absence Request (Faculty Only) Word Icon Leave of Absence Request (Faculty Only) PDF Icon  
  Extension of Probationary Period form (Faculty Only) Used with Faculty Leave of Absence   Extension of Probationary Period form (Faculty Only)PDF Icon  
  Leave of Absence Without Pay, Request form For staff and administrative personnel. Leave of Absence Without Pay, Request form word image Word Icon Leave of Absence Without Pay, Request form PDF Icon  

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Classification & Compensation

  Bonus Request Form   Bonus Request Form  
  Classification Review Request Form   Salary Offer Authorization Form  
  Head Start Action Request Form   Salary Offer Authorization Form  
In-Range Progression Request Form In-Range Progression Request Form
Performance Bonus Agreement Recruitment Bonus Agreement
Recruitment Bonus Agreement Retention Bonus Agreement
Retention Bonus Agreement Performance Bonus Agreement
Salary Offer Authorization Form Salary Offer Authorization Form

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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. Application for Staff/Administrator Application for Staff/Administrator (Non-Faculty) PDF Icon  
  Conditions of Employment Applies to all staff and administrative employees of San Francisco State University .   Conditions of Employment PDF Icon  
  Employee Information Form Completed by SF State employees. [Personal and Demographic Information] [Designee Form: person authorized to receive warrant][Oath Form: Oath of allegiance and declaration of permission to work for persons employed by the State of California][Update: Education and Professional License]   Form I-9, Employment Eligibility Verification (Revised 2/2/09) PDF Icon  
  Form I-9, Employment Eligibility Verification Employment information and verification.   Form I-9, Employment Eligibility Verification (Revised 2/2/09) PDF Icon  
  Form I-9, Instructions Employment information and verification.   Form I-9, Instructions (Revised 2/2/09)PDF Icon  
  Nepotism Compliance   Nepotism PDF Icon  
  Position Description for Staff Describe the duties, responsibilities and qualifications of the position. Position Description for Staff Word Icon Position Description for Staff PDF Icon  
  Position Description for Administrator (MPP) Describe the duties, responsibilities and qualifications of the position. Position Description for Administrator (MPP)  Word Icon Position Description for Administrator (MPP)  PDF Icon  
  Recruitment Authorization Use this form to obtain authorization to recruit for a position. Recruitment Authorization  Word Icon Recruitment Authorization  PDF Icon  
  Recruitment Minimum Qualifications Examples Sample Minimum Qualifications text. Recruitment Minimum Qualifications Examples  Word Icon Recruitment Minimum Qualifications Examples  PDF Icon  
  Special Consultant To appoint a special consultant. Special Consultant Word Icon Special Consultant PDF Icon  
  Staff Recommendation To recommend a candidate for hire. Staff Recommendation Word Icon Staff Recommendation PDF Icon
  Telecommuting Agreement To be completed annually by those enrolled in the program.   Telecommuting Agreement  PDF Icon
  Volunteer Agreement To acknowledge that services have been volunteered Special Consultant Word Icon Volunteer Agreement PDF Icon  
  Work Schedule To indicate an employee's work schedule.   Work Schedule PDF Icon Work Schedule  HTML icon

HRMS

Form #
Form Title/ Description
WORD
PDF
WEB
  HRMS Access Request Form - Requesting for ETRAC, Absence Management, Recruiting, Time & Labor (Time Sheets), Query HRMS access   Personnel Practice Directives
  Employee/Student Information Privacy (ESIP) Training     Personnel Practice Directives

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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   Clearance Request PDF Icon
  Personnel Practice Directives   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  PDF Icon  
  Absence and Additional Time Worked Report Instructions Instructions on how to complete the February 2006 revised Absence and Additional Time Worked Report.   Absence and Additional Time Worked Report Instructions PDF Icon  
  Authorization for Extra Hours Form required to authorize request to work overtime.   Authorization for Extra Hours PDF Icon  
  Direct Deposit Enrollment Authorization To enroll in direct deposit of paychecks.   Direct Deposit Enrollment Authorization PDF Icon  
  Dock Notice To notify Payroll that an employee is being docked.   Dock Notice PDF Icon Dock Notice HTML icon
  Employee Action Request To report changes of address and withholding allowance.   Employee Action Request PDF Icon  
  Honorarium Payment Request To request payment for presenter/lecturer at a campus event.   Honorarium Payment Request PDF Icon
  Information About Social Security Form Statement concerning employment in a job not covered by Social Security   Information About Social Security Form  PDF Icon  
  Leave Discrepancies Reporting Form Use this form to report discrepancies in your leave statement   Leave Discrepancies Reporting Form PDF Icon Leave Discrepancies Reporting Form HTML icon
  Non-USPS Adjustment Request--Payments (Fringe Benefit/Employee Business Expense)     Leave Discrepancies Reporting Form HTML icon
  Non-USPS Adjustment Request--Values (Fringe Benefit/Employee Business Expense)     Leave Discrepancies Reporting Form HTML icon
  Report of Extra Hours Worked Form required to record extra hours worked.   Report of Extra Hours Worked PDF Icon  
  Request for Duplicate W-2 To request duplicate W-2   Request for Duplicate W-2  PDF Icon  
  Savings Bond Authorization To purchase or change savings bond by payroll deduction.   Savings Bond Authorization  PDF Icon  
  Signature Authorization List   Student Payroll Action Request  PDF Icon  
  Student Payroll Voucher - Fall & Spring Student timesheet for the fall and spring semesters only.   Student Payroll Action Request  PDF Icon  
  Student Payroll Voucher - Summer Student timesheet for the fall and spring semesters only.   Student Payroll Action Request  PDF Icon  
  Student Payroll Action Request To obtain pertinent information for student employees, address changes, and withholding allowance.   Student Payroll Action Request  PDF Icon  
  Substitute Faculty Appointment To appoint substitute faculty.   Substitute Faculty Appointment  PDF Icon
  Warrant Designee To designate individual to receive final pay.   Warrant Designee  PDF Icon  

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Financial & Retirement

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

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Professional Development

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

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Safety & Risk Management

Form #
Form Title/ Description
WORD
PDF
WEB
  DSP Request for Authorization (Request for Authorization to Drive on University Business) Unit 4 Performance Evaluation Form Word Icon employment_PDF_Icon  
  Request for Foreign Travel Insurance Packet   employment_PDF_Icon  
  Request for Authorization to Travel/Travel Advance   employment_PDF_Icon  
  Notice of Travel Risks   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Participant List   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Release of Liability   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Release of Liability - Domestic Travel   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Release of Liability - Foreign Travel   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  SFSU - FTIP Coverage Summary   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Enterprise Rent-A-Car SFSU rates Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Field trip guidelines Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Property Insurance Request form Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Student Intern Insurance Request Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Notice to Employees-Injuries Caused by Work   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Predesignation form for Personal Chiropractor Acupuncturist Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Predesignation form for Personal Physician Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  SFSU FAQs- July2009 Unit 4 Performance Evaluation Form Word Icon Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Workers' Compensation Claim Form (DWC 1)   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Workers' Compensation Injury Illness   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  Foreign Travel - High-Risk Countries List Travel To High-Risk countries list PDF Icon  
  Request for travel to high-risk country   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  STD 269 - Accident Information Card   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  STD 270 - Vehicle Accident Report   Application for Subsequent Temporary Faculty Appointment PDF Icon  
  STD 274 - State Driver Accident Review   Application for Subsequent Temporary Faculty Appointment PDF Icon  

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Temporary Lecturer/Faculty

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

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