Benefits Enrollment Worksheet
Employee request to enroll or modify benefits enrollment.

 

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

 

Benefits - CalPERS Affidavit of Marriage
Allows certification of marriage when no marriage certificate is available.

 

Blue Shield Access + (HMO) and Net Value (HMO): Selecting Primary Care Physician
Form needs to be mailed to Blue Shield (HMO) with current or newly selected Blue Shield (HMO) physician(s) and medical group(s). 

 

Blue Shield Access+ and Net Value: Changing Primary Care Physician
Step-by-Step guide on how to change primary care physician.

 

CalPERS Beneficiary form

 

CalPERS Declaration of Health Coverage form

 

Catastrophic Leave Donation Request and Certification Form
Employee request for participation.

 

Delta Dental Claim Form
For employees to be able to submit dental claims.

 

FML - Family and Medical Leave Act
Summary of the Family and Medical Leave Act program.

 

FML - Health Care Provider's Certification for Family Medical Leave
Certification of employee's request for family medical leave to self or to care for eligible dependent.

 

FML - Family and Medical Leave Notice and Request Form
To process employee request for family medical leave.

 

Health Care/Dependent Care Reimbursement Enrollment
HCRA/DCRA new enrollment and open enrollment requests.

 

Health Care/Dependent Care Reimbursement Claim
To process employee HCRA/DCRA claims for 2008.

 

Injury/Illness Report
   - Reporting Injuries
     How to report injuries/illnesses.
   - Supervisor's Injury/Illness Report
     For supervisor to report an injury.
     Form must be completed by supervisor with employee.
   - Employee's Injury/Illness Report
     For employee to report an injury.

 

Leave of Absence Guide
Guide describing leaves of absence.

 

Leaves of Absence Request
To request a leave of absence.

 

Life - Employer Paid Life Certificate 2005
Certificate for group life insurance.

 

LTD - Employer Paid Certificate 2005
Certificate for group long term disability insurance.

 

Return-to-Work
   - Transitional Plan
   - Work Activity Analysis
   - Work Activity Analysis (Sample)
   - Employee Information Sheet
     Forms to be completed by supervisor for work related
     or non-work related transitional work due to work restrictions.

 

The Standard Life Insurance
Beneficiary form

 

TSA - 2009 Automated Tax Sheltered Annuity 15 year Catch-up Calculation Worksheet
To demonstrate eligibility for 15 year catch up contributions for TSA 403(b).

TSA - Tax Sheltered Annuity Companies
List of TSA (403b) plans.

Vision - Out-of-Network Reimbursement Form
To claim vision services with an out-of-network provider.

Vision - Video Display Terminal (VDT) Claim Form
To claim VDT glasses.

 

WC - Guide for Managers and Supervisors
A guide for managers and supervisors on the Workers' Compensation process and procedures.

 

WC - Industrial Disability Plan
To process application for industrial disability benefits.

 

WC - Employee's Description of Job Duties (DWC RU-91)
To describe job duties.  Completed by Supervisor and Employee.

 

WC - Employee's Description of Job Duties (DWC RU-91) Instructions
Glossary of terms for completing form (DWC RU-91).

 

WC - Predesignation of Personal Physician 
To designate personal physician in the event of a work related injury/illness.

 

Position Description Form
To describe positions submitted for classification reviews.

 

Request for In-Range Salary Progression Review
In-Range Salary Progression Guidelines
To request a permanent increase to a base salary within a salary range for a single classification.

 

Request for Reclassification Review
To request reviewing of a position and determining an appropriate CSU classification for all staff (non-faculty) positions.

 

CSUEB Employment Application
To apply for current employment vacancies.

 

Employee Self Appraisal Form
For employee to fill in prior to evaluation.

Performance Review Guide
PowerPoint slides

MPP Performance Review Form
To evaluate MPP's performance.

 

Staff Performance Review Form
To evaluate staff employees' performance (except Unit 3 and 4).

 

Unit 4 Staff Performance Review Form
To evaluate Unit 4 employees' performance.

 

Employee Separation Guidelines

 

Separating Employee Clearance Form
To process the resignation or retirement of employee.

 

Volunteer Appointment Form
To appoint and process CSUEB volunteers.

 

Recruitment and Selection Procedures for staff positions

Reference Check Form

Recruitment Request Form
To advertise a new position in the job bulletin.

 

 

Template - Application Screening Grid
To log scores during application screening (one per each selection committee member)

 

Template - Application Screening Summary
To total all scores of application screening

 

Template - Interview Rating Sheet
To note candidates answers and scores during interview

 

Template - Interview Results Summary
To log and total interview scores.