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HR Forms

Benefits

Form Use
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 Continuation Coverage Provided to eligible employees/dependents who wish to continue their medical care coverage after employer coverage ends.  Not available for download. 
Dental Enrollment Authorization Form Please use HR Benefits Worksheet to make dental plan enrollments, changes or cancellations. 
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 employee wishes to receive cash reimbursement in lieu of their CSU Health and/or Dental benefits. 
Health Benefits Worksheet  Used by an employee to inform HR of which Benefit 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 benefit vendors that we use on campus.
Vision Video Display Terminal Form (VDT Form) Contract your HR Analyst to request 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

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.

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 Rebecca Keenan at rkeenan@csusm.edu or at ext. 4429.
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 OHR
Note: Change of address can now be made directly through the portal at my.csusm.edu
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.
Outside Employment Disclosure Form (For MPP 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 MPPs ONLY!
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 VPs ONLY!
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.
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 Check In Sheet

To be used when hiring student and academic student employees. Hiring department to provide to student along with instructions to visit the HR department on or before first day of employment.

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.
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 Forms

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

The department must send this completed document to OHR at least 2 weeks prior to the start of the volunteer assignment for HR approval.

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.

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.
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.
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 Requisition 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.