Forms

Absence Slip

An employee uses this form to report use of vacation, sick leave, leave without pay, and compensatory time off.

Absence Slip MSWord

Absence Slip PDF

Academic Student Employee Letter

An academic department uses this template as required by Article 2 of the UC/UAW (ASE) Agreement. Modifications must be approved by Employee & Labor Relations prior to issuance to the potential employee.

Academic Student Employee Letter (MSWord)

Academic Student Employee Letter (PDF)

Access Violation Report

A department uses this form to report unauthorized or illegal activities by employee organizations. See P&P 380-21 for further information.

Access Violation Report (MSWord)

Access Violation Report (PDF)

Benefits Forms

This link will take you to the Benefits forms page, which includes insurance enrollment and COBRA notification forms, among others.

University of California State Oath of Allegiance Agreement form

Catastrophic Leave Sharing Program

This program allows an employee to donate accrued vacation to support a colleague who has exhausted his or her paid leave due to a catastrophic illness. Departments are responsible for telling an employee about this program if it is likely that he or she could be an eligible recipient.

Exhibit A: Permission to Release Medical Information

Exhibit B: Request for Donations

Exhibit C: Catastrophic Leave Donation

Leave Hours Adjustment Worksheet (UPAY 3-640C)

Child Abuse Notification

A department uses this form when a new employee is hired in a position designated as a "mandated reporter" under the California Child Abuse and Neglect Reporting Act and UCD Policy & Procedure Manual Section 380-81.

Mandatory Reporter Form -MS Word

Mandatory Reporter Form - PDF

Compensatory Time Off Election

The PPSM Compensatory Time Notification form is used to document the employee's agreement that the department can choose whether to compensate premium overtime with pay or compensatory time off. The CX, SX, F3, TX, RX or HX Compensatory Time Agreement form is used to document the employee's annual agreement on a method of compensation.  

Contract Appointments

A contract appointment is an appointment established at a fixed or variable percentage of time for a definite period. Terms and conditions of employment are specified in a written employment contract. See PPSM UCD Procedure 3 for procedures.

Professional & Support Staff Contract - Exempt Employees (MSWord)

Professional & Support Staff Contract - Nonexempt Employees (MS Word)

Manager & Senior Professional Contract (MSWord)

DMS Forms

Disability Management Services(DMS) Forms include: Temporary Accommodation; Reasonable Accommodation Record of Action and Medical Separation.

Elder Abuse Notification

Employees who are likely to provide health or social services to elders or dependent adults must sign a statement that they are aware of the law and will comply with its provisions.

Elder/Dependent Adult Abuse - Employee Notification (MSWord)

Elder/Dependent Adult Abuse - Employee Notification (PDF)

Emergency Information

A department uses this form to give an employee an opportunity to provide information that may be useful should there be a medical or other emergency at work.

Emergency Information (MSWord)

Emergency Information (PDF)

Employee Development Worksheet

A supervisor uses this form for evaluations that are not part of the annual performance appraisal process (e.g. for probationary or limited employees, or regular status employees at a time other than the annual review). The forms should be retained by the department.

Employee Development Worksheet MSWord

Employee Development Worksheet PDF

License or Certification Requirements and Verification

The department must verify the applicants license upon hire, promotion, transfer, or reclassification if it is required for the job by law.  Contact your Employment Consultant/Recruiter for more information. 

License or Certification Requirements and Verification

Near Relatives Request

For more information about the use of these documents please contact your Employment Consultant/Recruiter or your Employee and Labor Relations Consultant

Near Relative Request for New Hire Employment

Near Relative Request for Change of Relationship of Employees in the Same Department

Notice of Intent to Change Terms & Conditions of Employment

Departments cannot take unilateral action to change established terms & conditions of employment (e.g., work rules, such as dress code or time keeping system) without providing notice to the unions through Employee & Labor Relations.  Please refer to specific contract for notice timelines.

A department uses this form to ask Human Resources to provide notice to a union of a proposed change in the terms and conditions of employment.

Notice of Intent to Change Conditions of Employment (MSWord)

Notice of Intent to Change Conditions of Employment (PDF)

Partial Year Career Certification

A department uses this form to notify an employee at the time of hire that there will be annual furlough periods.

Partial Year Career Certification MSWord

Partial Year Career Certification PDF

Partial Year Furlough Notice

A department uses this form to notify an employee at the beginning of each furlough period.

Partial Year Career Furlough MSWord

Partial Year Career Furlough PDF

Probationary Period Report

A department uses this form to report the results of the probationary evaluation, extend the probationary period, end employment of probationary employees, or certify the attainment of career status.  Please refer to the relevant contract or policy section on probationary status for specific information about timelines and evaluation requirements.

Probationary Period Report (MS Word)

Probationary Period Report (PDF)

Staff Leave Request Form

Vacation Plan Worksheet

An employee and supervisor use this form when the employee is at or near the maximum vacation accrual.

Vacation Plan Worksheet (MSWord)

Vacation Plan Worksheet (PDF)

Request to Exceed Maximum Vacation Accrual Limit (MSWord)

Request to Exceed Maximum Vacation Accrual Limit (PDF)

Verification of Previous Employment

This form is to be used for employees who have employment service credit with another UC, DOE (Department of Energy) Lab, or State of California service. 

Directions:  The employee should complete the form with all relevant information, print & sign, and then mail it to their former employer.  The section in yellow is to be completed by the employee - please fill in the mailing address of your current department's payroll processor.  Your former employer will then mail the completed form directly to them.

Verification of Previous Employment (MS Word)

Verification of Previous Employment (PDF)

Volunteer Information Record (Form)

This form is used to obtain demographic information from volunteers and volunteer activity information from departments. The form should be completed by all non-employee volunteers. The purpose of the information is to determine eligibility for possible workers compensation benefits in the event that the individual is injured while providing volunteer services to the University.

Volunteer Form (MSWord)