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HR Forms

Benefits

Benefits & Forms
Form Use
Benefits Enrollment Worksheet used to enroll, make changes or cancel Health, Dental or FlexCash elections. Supporting documentation may also be resuired. Send completed form to hrbenefits@csusm.edu
Benefit Provider Contacts A list of 1-800 numbers and web links to various health, dental, vision, retirement, and benefit vendors that we use on campus.
CalPERS Beneficiary Designation Form Used to identify or change a PERS employee's beneficiary. This is managed directly through CalPERS.
CalPERS Service Credit Purchase Options CalPERS website to explain the types of Service Credit Purchase Options and how to submit a request.  Questions should be directed to CalPERS.
Catastrophic Leave Donation Form - HR Used to donate vacation or sick accruals to employees in need of extra sick time due to a catastrophic event.
COBRA Continuation Coverage Provided to eligible employees/dependents who wish to continue their medical coverages after EmployerGroup Coverage ends.  Not available for download. 
Dental Enrollment Authorization Form Use the Benefits Enrollment Worksheet to make dental plan enrollments, changes or cancellations. Send completed form to hrbenefits@csusm.edu
Dependent Care Reimbursement Enrollment Form via AdobeSign Used to enroll in the Flexible Spending -  Dependent Care Reimbursement Account (DCRA) Program for the 2024 Plan Year.  Form is through AdobeSign - Select Form Name from WorkFlow Selector Dropdown.

Dependent Care Reimbursement Claim Form (ASIFlex) Used by employee to claim reimbursements under the DCRA program. Completed form is submitted directly to ASIFlex for processing.
Fee Waiver - CSU Application Fee Reimbursement Used by eligible employees, spouses, domestic partners, or dependent children who are requesting reimbursement of the CSU Application fee under the provisions of the CSU Tuition Waiver Program.  Form is through AdobeSign - Select form name from WorkFlow Selector Dropdown.
Fee Waiver - Employee Application Use to enroll in the Tuition Fee Waiver and Reduction Program.  Form is through AdobeSign - Select form name from WorkFlow Selector Dropdown.
Fee Waiver - Career Development Form Used in conjunction with the Employee Fee Waiver Application when the classes enrolled in are used for Career Development.  Form is through AdobeSign - Select form name from WorkFlow Selector Dropdown.
Fee Waiver - Dependent Application Used when Staff member wishes to transfer his/her Fee Waiver Benefit to a dependent. Form is through AdobeSign - Select form name from WorkFlow Selector Dropdown.
FlexCash Enrollment Authorization Used when an employee has their own health and/or dental coverage (outside of the CSU) and elects to receive cash in lieu of their CSU Health and/or Dental benefits. 
Health Enrollment Authorization Form Use the Benefits Enrollment Worksheet to make health plan enrollments, changes or cancellations.  Send completed form to hrbenefits@csusm.edu
Health Care Reimbursement Enrollment Form - via Adobe Sign Used to enroll in the Flexible Spending -  Health Care Reimbursement Account (HCRA) Program for the 2024 Plan Year. Form is through AdobeSign - Select Form Name from the WorkFlow Selector Dropdown.
Health Care Reimbursement Claim Form (ASIFlex) Used by employees to claim reimbursements under the HCRA program. Completed form is submitted directly to ASIFlex for processing.
Maternity/ Paternity/ Adoption Paid Leave Application Used by individuals to request paid leave for Maternity, Paternity or Adoption.
VSP Premier Enrollment Form Enrollment form used by employees who wish to voluntarily enhance their vision coverage.  Employees must enroll all eligible dependents they wish to maintain vision benefits, as those not included will not be able to seek services under the basic plan.
VSP Reimbursement Form To be completed and submitted to VSP when using services out-of-network and requesting to be reimbursed for the amount covered under the pay.
VSP Computer Vision Care (CVC) Form For employees who qualify for Computer Vision Care (CVC) benefits. Please contact your HR Analyst to determine benefit eligibility and obtain the CVC claim form. Employees who qualify for the CVC benefit will complete the form and submit to their eye care provider. 
VSP Retirement Enrollment Form Used by Retirees who wish to continue Vision coverage into retirement.

Compensation/Classification

Compensation Forms
Form Use
Bonus Stipend Form  
Classification Review Request Form Classification Review requests are submitted by the appropriate administrator for the department involved. See the guidelines for requesting a Classification Review. (Select: FA-Human_Resources(HR)-Classification_Review_Request_Form)
Classification Review Guidelines Instructions for using the Classification Review Request form and Bargaining Unit requirements.
In-Range Progression Request Form In-Range Progression requests are submitted by the appropriate administrator for the department involved. See the guidelines for requesting an In-Range Progression. (Select: FA-Human_Resources(HR)-IRP_Request_Form)
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

General HR Forms
Form Use
CalPERS Member Reciprocal Certification

Completed by new hires to determine existing CalPERS membership status.

Confidentiality Statement Confidentiality Statement ensures that the employees understand 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.
Conflict of Interest (Form 700) Use this form whenever you are Assuming Office, Leaving Office, or filing annually. For questions about filing procedures, please contact Justine Cook at jcook@csusm.edu or at ext. 4427.
Contractor-Consultant Determination Form Select "FA-Human_Resources(HR)-Contractor_Consultant_Determination_Form" from the drop-down menu. Submit this form to appropriate HR Analyst regarding details of a non-staff/faculty assignment. Additional information can be found on the Additional Appointment website.
Faculty/Lecturer Check In Sheet

To be used when hiring adjunct faculty or lecturer employees. Hiring department to provide to faculty member along with instructions to visit the HR department on or before first day of employment.

Form I-9 Federal form to document work authorization for all employees.
Form I-9 - List of Acceptable Documents 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 Action Form   
MPP Performance Evaluation Forms Please refer to the Performance Evaluation Forms webpage.
Outside Employment Disclosure Form Form used to report outside employment as a precondition of employment, within 30 days of accepting outside employment, within 10 days of supervisor/administrator request, and annually. Wet signature required.
Outside Employment Disclosure Form (For Senior Management Employees) Form used to report outside employment as a precondition of employment, within 30 days of accepting outside employment, within 10 days of supervisor/administrator request, and annually. To be completed by Executive employees and VP's ONLY.
Payroll Clearance Checklist Separation checklist for exiting employees.
Performance Evaluation Forms Please refer to the Performance Evaluation Forms webpage.
Personnel Information Sheet Used to update your degree information, emergency contact information, and/or designee for state warrant on your personnel record.
Special Consultant Appointment Form Used to request appointment for Special Consultant. Please visit the Special Consultant webpage for the definition/description of a special consultant, guidelines and checklist, hiring and approval process, and roles and responsibilities of the various levels of the appointment.
Student Employee Hiring Process Guide
Employment guidelines for hiring and maintaining student employment. NOTE: This does not apply to Unit 11 employment.
Student Information Sheet Used by student employees who need to update their degree information or emergency contact information for the personnel record.
Student Sign In Process Used when hiring student and academic student employees. 
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 of Ethnicity Voluntary form used to capture or update ethnic status of employees.
Voluntary Self-Identification of Disability Voluntary form used to capture or update disability status of employees.
Voluntary Self-Identification of Veteran  Voluntary form used to capture or update veteran status of employees.
Volunteer Form

Completed when someone would like to volunteer his/her time at the University.

W-4 Form To change Tax Withholding Information, employees complete the Employee Action Request form (EAR)
Work Schedule

To establish  an employee's  work schedule (New/Rehire) or change an exisiting employee's work schedule.(Select: FA-Human_Resources(HR)-Work_Schedule_Form)

This form will need to be routed to your assigned HR Analyst and assigned Payroll Technician. 

Payroll

Payroll Forms
Form Use
Catastrophic Leave Donation Form - Payroll 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.
Employee Action Request (STD 686) 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 OHR
Note: Change of address can now be made directly through the portal at my.csusm.edu
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.
Request for NonDisclosure of Employee Home Address Used by employees to request non-disclosure of home address and home phone number. Please review form in its entirety for more information.
Retirement Estimation Program A link to the CalPERS site.
Special Consultant Timesheet

Used to document a Special Consultant / time worked.

  • (Select: FA-Payroll- Special_Consultant_Timesheet)*
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. Wet Signature required.
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.

Recruitment

Recruitment Forms
Form Use
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.
ARF (Applicant Rating Form) Used by search committee to rate candidates. Refer to Interview Selection and Guidelines for use below.
IRF (Interview Rating Form) Used by search committee 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 Requisition (Job Card) Used by a department to initiate the search for a new or replacement employee. 

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.
Reference Check Guidelines If you are serving on a search committee this will help you understand the reference check process.

* all eSignature forms have changed to Adobe Sign