Center for Human Resources

Health Care

Affidavit of Eligibility for Economically Dependent Children
Allows for the enrollment of a child (other than natural, adopted or step-child) in the CalPERS sponsored health programs.

Benefits Enrollment/Change Form
A worksheet for employees to designate their dental, medical and flexcash options (opting out of benefits).

Declaration of Health Care Coverage
A CalPERS-required form for enrolling into or opting out of benefits.

Delta Dental Claim Form
Used by employees if a Delta Dental provider does not bill directly for services.

HIPPA Authorization Form
Employee Authorization for Benefits staff to use and/or disclose personal health plan information.

VSP Out-of-Network Reimbursement Form
Vision reimbursement form for employees who utilized the services of a non-network doctor.

VSP Video Display Terminal (VDT) Confirmation Form
Vision form for employees who meet the job requirements for the VDT benefit that is given to a VSP Network doctor.

Flexible Benefits

Dependent Care/Health Care Reimbursement Account Plans Enrollment Authorization
Enrollment form used to establish Health Care and/or Dependent Care reimbursement accounts.

Dependent Care/Health Care Claim Form
Used to establish a dependent and/or health care reimbursement account.

Direct Deposit Form for Dependent Care/Health Care
For employees who wish to receive their Flexible Spending Accounts reimbursements by direct deposit.

FlexCash Program Enrollment Authorization
Forms used to “opt out” of medical and/or dental benefits.

Medical-Related Leaves

Leave of Absence Request Form
For employees who wish to request a leave of absence for medical, family medical leave, parental, pregnancy, military, education, personal or other leaves.

Survivor Protection Benefits

Life and AD&D Beneficiary Designation and Change Form
To designate or change the beneficiary of the employer-paid Life and AD&D benefit.

Retirement Plans

TSA Maximum Contribution Worksheet
For individuals who want to contribute more than the annual maximum and are age 50 or older and/or a 15-years of service.

Additional CSU Benefits
Fee Waiver

CSU $55 Application Fee Waiver
Allows for the waiver of the application fee to one CSU campus.

Career Development Plan
To be completed by employees who are pursuing a degree program.

Dependent Fee Waiver Form
To be used when eligible dependents will be utilizing the employee’s fee waiver benefit.

Employee Fee Waiver Form
To be completed by employees who will be utilizing the fee waiver benefit.

Political Reform Act 2008
A description of the Political Reform Act published by the Fair Political Practices Commission.

2008/2009 Form 700 Statement of Economic Interest Reference Pamphlet
California Fair Political Practices Commission — explanation of who must file and how to file.

San Diego State University Designated Positions
List of Designated Positions associated with the Statement of Economic Interest. The list is established through the Chancellor’s Office.

Your Duty to File — A Basic Overview of State Economic Disclosure Law and Reporting Requirements for Public Officials
A guide explaining why an employee in a designated positions is required to file. The pamphlet is produced by the Fair Political Practices Commission.

CSU (California State University) Conflict of Interest Disclosure Categories
The list gives employees in designated positions a description of each category that is required to submit the Form 700 Statement of Economic Interest form annually.

Form 700 Statement of Economic Interest
Form 700 pamphlet includes instructions and forms for employees in designated positions to complete the form annually.

Compensation

Discretionary Pay Increase Unit 4 Recommendation
Form used to request a discretionary pay increase for Unit 4 employees.

In-Range Progression Guidelines and Forms
Form used to submit an in–range progression request.

Employment

Confidential Employees Human Resources Program Guidelines
Guidelines pertaining to the confidential classifications.

Employment Verification
Form used to request employment verification letter

Federal Work Study (FWS) Job Description
Form used to post available FWS positions. Please contact Federal Work Study Division Coordinator with questions

Form I-9, Employment Eligibility
Form used to establish employment eligibility and to reestablish if new work authorization has been obtained

Hiring Freeze Exemption Request
Form used to supplement the Position Requisition form during a hiring freeze.

Position Description
Form used to create, post, or modify an existing position on campus.

Position Requisition
Form used to initiate filling a vacancy or a new position.

Staff Transaction Form
Form to appoint, reappoint, end, or modify an appointment for staff employees

Student Employment Authorization Form
Form to hire non academic student assistants.

Unit 11 Job Vacancy Announcement
Form to compose, submit, and post available positions within colleges for teaching associates, graduate assistants, and instructional student assistants.

Volunteer Identification Form
Form used to appoint volunteers.

Performance Evaluations

Confidential Employees
Form used to evaluate the work performance of confidential employees.

Management Personnel
Form used to evaluate the work performance of management level employees.

Performance Evaluation for Units 2, 5, 7 & 9
Form used to evaluate the work performance of CSUEU represented employees.

Unit 4
Form used to evaluate the work performance of Unit 4 employees.

PeopleSoft Human Resources Account Access Request
Form to gain additional access to PeopleSoft.

Oracle Apps & Markview Imaging Account Access Request Form
Form to gain access to MarkView/Oracle.

PeopleSoft Password Guide
This guide will walk you through the steps to establish, change and retrieve a forgotten PeopleSoft password.

PeopleSoft Employee Self Service Guide
This guide will walk you through the steps to access your personal information.

PeopleSoft Manager Self Service Guide
This guide will walk you through the steps to access your employee information.

PeopleSoft Delete Cache Guide
This guide will walk you through the steps to delete cache from your computer, improving system performance.

Direct Deposit Form
Used to enroll/change/cancel direct deposit.

Employee Action Request (EAR)
Used to update employee name, address and/or withholding status.

Student Payroll Action Request (SPAR)
Used to update student employees’ name, address, and/or withholding status.

Authorization for Business–Related Wireless Devices
Used to request reimbursement for initial device acquisition and⁄or service plan allowance.

Attendance Summary
Used to report attendance: hours worked (hourly staff) or absences (salaried staff)

Authorization for Extra Hours (Overtime Form)
Used to report extra hours worked either for payment or compensating time off.

Foreign National Information Form (FNIF)
Used by foreign employees to determine tax residency status.

Student Employment Authorization Form (SEA)
Used by department timekeepers to appoint student employees into temporary positions.

Student Assistant Time Card
Used by students to report hours worked to their supervisors.

Federal Work Study Time Card
Used by Federal Work Study students to report hours worked to their supervisors. Instructions included.

Student Assistant Attendance Report
Used by department time keepers to report a summary of hours worked for a group of students.

Duplicate Wage & Tax Statement Request
Used by employees or Payroll staff to request duplicate W-2 Forms.

President’s Management Development Application Form
Application form that is submitted in August.

Supervisors Academy Application Form
Application form that is submitted in August.

Workers’ Compensation Claim Form (DWC 1)
Form to be completed by an injured employee.

Supervisor’s Report of Work-Related Accident/Illness Form
Form that the supervisor of an injured employee completes.

Notice of Pre-Designation of Physician
For employees who would like to pre-designate a physician before a work-related injury/illness occurs.