Payroll and Benefits Forms

Payroll and Benefits

Vouchers for Processing Payment

Authorization For Extra Hours

Digital Student Assistant, Instructional Student Assistant, and Hourly/Intermittent Payroll Voucher

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

Absences

Funeral and/or Bereavement Request Form

Plus/Minus, Shift, and ADO Attendance Tracking Worksheet

For alternate work schedules

Report of Absence Without Pay (Notice of Dock)

Signature Authorization Form - Master Payroll

Signature Authorization Form - Student/Hourly Intermittent Payroll

Benefits

2022 Health Care and Insurance Monthly Premium Rate Chart

2022 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 Out-of-Network Reimbursement Form

VSP Vision Care Premier Enrollment Form

ADA Accommodations

Authorization Form

Reasonable Accommodation Request Form

Verification of Disability Form

Direct Deposit

Direct Deposit Enrollment Authorization

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

Changing your address, name, or withholdings - Employee Action Request (EAR)

Please be sure and read the important Information and guidance for determining your tax withholdings before submitting the EAR

Designation of Person(s) Authorized to Receive Warrants

Determining your "take-home" Pay or net amount after taxes and deductions