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HR Forms

Benefits

CalPERS Beneficiary Designation Form Used to identify a PERS employee's beneficiary. This form is a triplicate form and not available for download.  Please request via email.
CalPERS Separation Form Used when a PERS employee leaves the University - to indicate what he/she would like done with his/her PERS contributions. This form is a triplicate form and not available for download. Please request via email.
CalPERS Service Retirement Form Used by CalPERS employees to apply for service retirement.  This form is not available for download. Please request via email
Catastrophic Leave Donation Form Used to donate vacation or sick accruals to employees in need of extra sick time due to a catastrophic event.
COBRA Dental Form Used to enroll in COBRA dental coverage
This form is not available for download.  Please request via email.
COBRA Election Form Used to designate if employee would like benefits to continue, when he/she is no longer eligible for benefits coverage (separation, dependent turns 23, etc.) Not available for download. Please request via email.
COBRA Health Form Used to enroll in COBRA health coverage
This form is not available for download.  Please request via email.
COBRA Vision Form Used to enroll in COBRA Vision coverage
This form is not available for download.  Please request via email.
Dental Enrollment Authorization Form Please use HR Benefits Worksheet to make dental plan enrollments, changes or cancellations. Please request via email.
Dependent Care Reimbursement Enrollment Form Used to enroll in Dependent Care Reimbursement Account Program.
Dependent Care Reimbursement Claim Form (ASI) Used by employee to claim reimbursements under the DCRA program.
Fee Waiver - Admission Reduction Eligibility Form Used by employees to attach to the CSU Application form in lieu of payment. Contact HR at x4418 for more information.
Fee Waiver - Staff Application Use to enroll in the Fee Waiver Program
Fee Waiver - Career Development Form Used in conjunction with the Fee Waiver Application when the classes enrolled in are used for Career Development.
Fee Waiver - Dependent Form Used when Staff member wishes to transfer his/her Fee Waiver Benefit to a dependent.
FlexCash Enrollment Authorization Used when staff member wishes to receive cash reimbursement in lieu of Health benefits. Complete Sections 1 through 6 only, print hard copy, turn in to HR with original signature.
Health Benefits Worksheet - (Must be printed on pink paper) Used by an employee to inform HR of which Benefits choices he/she has made.
Health Care/Dependent Care Reimbursement Enrollment Form Used by employee to enroll in Health Care Reimbursement Account Program.
Health Care Reimbursement Claim Form (ASI) Used by employees to claim reimbursements under the HCRA program.
Maternity/ Paternity/ Adoption Paid Leave Application Used by individuals to request paid leave for Maternity, Paternity or Adoption.
Retirement Estimation Program A link to the CalPERS site
UC Benefits Retirement Forms Used when a UC Contribution Plan employee leaves the University - to request reimbursement or roll over of UC Contribution Plan contributions  
** note ** this does not refer to work done at the UC system - it is a type of plan used here at CSUSM for certain types of temporary employment.
This form is not available for download.  Please request via email.
Useful Numbers & Web Links A list of 1-800 numbers and web links to various health, dental, vision, retirement, and credit union vendors that we use on campus. Please request via email.
Vision Video Display Terminal Form (VDT Form) Claim form to take to vision care provider. Used solely by the employee when he/she qualifies for Video Display Terminal (VDT) benefits. Employee (or patient, if not employee) must take this form to eye appointment.
VSP Retirement Enrollment Form Enrollment form used by employees (retired) who wish to continue Vision coverage into retirement.

Compensation/Classification

In-Range Progression Review Form In-Range Progression requests are submitted by the appropriate administrator for the department involved. See the Guidelines for requesting an In-Range Progression.
In-Range Progression Guidelines Instructions for using the In-Range Progression Review form and Bargaining Unit requirements. 
Lead Worker ID Form Used by departments to identify Lead Workers.

HR General

Adjunct Faculty Employment Information Sheet Hiring department (HD) provides this checklist to all new lecturers/adjunct faculty employees to bring with them to the Human Resources office when they are hired. The checklist outlines what will be required at the time they sign-in with HR; HD should also note correct job code/title and start date on the form which will assist in signing the new employee on to the state payroll system.
Confidentiality of Employee, Student and Faculty Data Statement (for staff) Confidentiality of Employee, Faculty and Student Data Document to ensure that the employee understands the state and federal laws and university policies that govern access to and use of information contained in the employee, applicants, and student records, including data that is accessible through any university human resource information system. To be signed by Manager and Employee.
Employee Action Request Form (EAR) Multiple purpose form to be used for one of the following for a staff, faculty or administration member:  sign in an employee, change of address, change of tax withholdings, change of name, or change of birth date. This form is a triplicate form; if you download it, you must submit 3 copies. Or, request a 3-part NCR form from HREO
Note: Change of address can now be made directly through the portal at my.csusm.edu
Employee Performance Evaluation Forms Please refer to the Performance Evaluation Forms webpage.
Form I-9, Employment Eligibility Verification A listing of acceptable identification to use when an employee (of any type) is hired.
HRIS Access and Compliance Form (For Faculty) Form used to certify that faculty member has received training on the appended state and federal laws and University policies that govern access to and use of information contained in employee, applicant, and student records, including data that is accessible through the PeopleSoft Human Resource System.
MPP Performance Evaluation Forms Please refer to the Performance Evaluation Forms webpage.
Payroll Clearance Checklist Checklist for exiting employees.
Performance Evaluation Forms Please refer to the Performance Evaluation Forms webpage.
Special Consultant Agreement Form Used to request appointment for Special Consultant. The form also includes a definition/description of a special consultant, hiring and approval process, and roles and responsibilities of the various levels of the appointment.
Special Consultant Independent Contractor Guide and Checklist Used to define and compare Special Consultant and Independent Contractor
Student Employment Information Sheet Student Employment Information Sheet (Unit 11) Hiring department (HD) provides this checklist to all student employees to bring with them to Human Resources Office when they are hired.  The checklist outlines what will be required at the time they sign-in with HREO;  HD should also note correct job code/title on the top of the form which will assist in signing the new student on to the payroll system. For more information see the Student Employee Hiring Process guide.
Telecommuting Agreement Form The Telecommuting program at California State University San Marcos is designed to provide flexibility in work options. See the University Policies and Procedures for more information.
Voluntary Self-Identification Form for Employees This form is used by employees to recapture and submit diversity/ethnicity data.  Complete and submit hard copy to HREO.
Volunteer Employment Forms Completed when someone from the community would like to volunteer his/her time at the University
This form is in PDF format for use with Adobe Acrobat Reader.
Provides detailed information on the CSUSM Volunteer Process. A step-by-step checklist of instructions for departments to follow when appointing volunteers. The department must send this completed document to HREO at least 2 weeks prior to the start of the volunteer assignment for HR approval. Used by volunteers to submit to their department prior to starting the volunteer assignment. The department sends to HREO with a copy of the approved Description of Volunteer Duties form attached.
W-4 Form See the Employee Action Report (EAR) form above to change Tax withholding information

Payroll

Catastrophic Leave Donation Form Used to donate vacation or sick accruals to employees in need of extra sick time due to a catastrophic event.
Direct Deposit Form
(STD 699)
Used to enroll in or make changes to the direct deposit of an employee's pay warrant.
Paycheck Calculator Use this downloadable excel spreadsheet to see what your pay warrant will be after taxes.  This form allows you to modify your withholdings and TSA amounts before you actually make the change through payroll.
Personnel Information Sheet (to be printed on blue paper only) Multi-use form used by staff, faculty, and management employees when they are hired, need to change their emergency contact, or, designate someone to receive final pay warrants. This form is not currently available for download.  Please request via email. 
Retirement Estimation Program A link to the CalPERS site
Special Consultant Timesheet Used to document a Special Consultant / time worked.
Student Assistant Payroll Action Request (STD457) Multiple-use form to be used for one of the following for a student employee:  hire, change address, change tax withholdings, change  name, or correct birth date. 

You may download the form from the Payroll Services website (provide two signed copies to Payroll) -or- request the  triplicate form via email.
Time Sheet - Student Employee Used to identify the hours worked by a Student Assistant (regular student assistant, federal work-study, or bridge student assistant). Request via email.
Voluntary Child Support Form Used by an employee to set up automatic deduction for Child Support payments from his/her pay warrants
This form is not available for download.  Please request via email.

Recruitment

Applicant Authorization Release Form Used by applicants to authorize CSUSM to conduct reference and employment background  checks - this is an Adobe Acrobat document - you will need Adobe Reader to view the document.
IRF (Interview Rating Form) Used by interview committees to rate interview candidates. Refer to Interview Selection and Guidelines for use below.
Interview & Selection Guidelines Guidelines to assist the hiring manager and participants of a search committee involved in the selection of personnel.
Personnel Action Notice form (Printed on PINK PAPER ONLY) Used to create or make changes to a Staff or Student employee's appointment. Available for download.
Personnel Action Notice Guidelines Instructions for completing the PAN form. Available for download.
Personnel Requisition
(to be printed on grey paper only)
Used by a department to initiate the search for a new or replacement employee. This form to be printed on grey paper only.
Position Description Template (Staff)
Position Description Template (MPP)
Used to create official description of a staff or MPP position. It describes the purpose, duties, responsibilities and requirements of the position.
Recruitment Procedure Checklists With Committee
Without Committee
The checklist/guidelines used by search committees to fill available positions
Reference Check Guidelines If you are serving on a search committee this will help you understand the reference check process.

Training

Fee Waiver - Admission Reduction Eligibility Form Used by employees to attach to the CSU Application form in lieu of payment.  Contact HR at x4419 for more information.
Fee Waiver - Staff Application Use to enroll in the Fee Waiver Program.
Fee Waiver - Work Related Registration Form Used to register in work related classes.
Fee Waiver - Career Development Form Used in conjunction with the Fee Waiver Application when the classes enrolled in are used for Career Development.
Fee Waiver - Dependent Form Used when Staff member wishes to transfer his/her Fee Waiver Benefit to a dependent.