Payroll and Benefits Forms

Payroll and Benefits

Vouchers for Processing Payment

Digital Student Assistant, Instructional Student Assistant, and Hourly/Intermittent Payroll Voucher
Overtime Reporting - Authorization for Extra Hours Worked
Staff Special Consultant Voucher
Staff Special Consultant Voucher Process Flow

Leaves of Absence

Catastrophic Leave Donation Form
Employee Rights and Responsibilities Under FMLA Poster
Medical Certification for Employees Form
Medical Certification for Family Members Form
Notice B: "Family Care and Medical Leave and Pregnancy Disability Leave"
Request for Leave of Absence Form
Return to Work Certification

Tuition Waiver

CSU Application Fee Reimbursement Request
Dependent Tuition Waiver Transfer Application
Faculty and Staff Tuition Waiver Application
Individual Career Development Plan form
Work Related Enrollment Request

Absences

Absence Report
Funeral and/or Bereavement Leave Request Form
Plus/Minus, Shift, and ADO Attendance Tracking Worksheet

For alternate work schedules
Report of Absence Without Pay (Notice of Dock)

Benefits

2024 Summary of Benefits and Coverage Notice
Benefit Enrollment/Change Worksheet
Domestic Partner Tax Dependent Certification Form
HCRA/DCRA Enrollment Form
New Hire Benefit Eligibility Under the Affordable Care Act (ACA)
Temporary Staff and Faculty Benefit Summary Information
The Standard New Enrollment and Change Form
VSP Computer Vision Glasses Confirmation Form
VSP Request for Reimbursement Form
VSP Vision Care Premier Enrollment Form

ADA Accommodations

Authorization Form
Reasonable Accommodation Request Form
Verification of Disability Form

Direct Deposit

Direct Deposit - Cancellation Only
Direct Deposit - Enroll/Change

This link will take you to the Business Process Guide for registering and establishing (or changing) your Direct Deposit for payroll warrants through the State of California.

Worker’s Compensation

Employee Claim for Workers' Compensation Benefits Form (DWC-1)
Employee Designation of Physician Form
Supervisor's Report of a Work Related Injury/Illness

Retiree Benefits

CSU Retiree Voluntary Vision Program Enrollment Form
Retiree Dental Enrollment Change Request Form

Other

403(b) SRP Salary Reduction Request Form
CalPERS Special Power of Attorney
Designation of Person(s) Authorized to Receive Warrants

Payroll Changes

Determining your "take-home" Pay or net amount after taxes and deductions
Employee Action Request (EAR)

Changing your address, name, or withholdings. 
Withholdings Change via Cal Employee Connect

This link will take you to the CEC Withholdings Change User Guide which outlines the functionality of the Withholdings Change form available via Cal Employee Connect.