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Form Template/Title Form Used For Related KB Articles Population
Residents and Clinical Fellows - Declaration of Domestic Partnership Declaration of domestic partnership in accordance with criteria and eligibility for trainee health plansTrainee
Benefits
UPAY 850: Health and Welfare Plan Benefit Change Form Enrolling in, changing, de-enrolling/cancelling, or opting out of insurance and/or flexible spending account plans for yourself and/or your eligible family membersAcademic,Staff
Benefits
Consent to Release Information Form Authorizes Faculty and Staff Assistance Program to release records to individuals/agencies designated on formGeneral
none
Remote Worker Agreement Template Establishing a remote work arrangement; not to be used for telecommutingStaff
Appointment Maintenance
Home Safety Checklist for Telecommuting Ensuring a clean, safe, and ergonomically sound home/work office as condition for telecommutingStaff
Appointment Maintenance
Health Sciences Compensation (HSC): Long-Term Disability Claim Form Applying for long-term disability income benefitsAcademic
Leave Management
Residents and Clinical Fellows - Beneficiary Designation Form Beneficiary designation for UCSF residents and fellowsTrainee
Benefits
Compensatory Time Off (CTO) Election Form: CNA Nurse Employees (NX) NX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: CUE Clerical Employees (CX) CX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Health Care Professional Employees (HX) HX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Patient Care Technical Employees (EX) EX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Professional and Support Staff (PSS) (non-exempt) Employees PSS agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Research Support Professionals (RX) RX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Service Employees (SX) SX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Compensatory Time Off (CTO) Election Form: Technical Employees (TX) TX agreement form to accept compensation for overtime in the form of compensatory time offStaff
Labor & Employee Relations
Salary Calculation Worksheet for HSCP Faculty Determining HSCP faculty salaries based on NIH salary capsStaff
Classification and Compensation
Salary Calculation Worksheet for HSCP Ineligible Faculty Determining HSCP-ineligible faculty salaries based on NIH salary capsStaff
Classification and Compensation
Residents and Fellows Payroll Keying Service Agreement Form Agreeing to use residents and fellows payroll keying service, which is outside of the HR Services RechargeStaff
none
SLCG Item Request Form Requesting compensation reviews for MSP and SMG employeesStaff
Classification and Compensation
Residents and Clinical Fellows - COBRA Acknowledgment Form Explains right to COBRA continuation coverageStaff,Trainee
Benefits
Personnel Policies for Staff Members (PPSM)-70 Complaint Resolution Review Form For employees to make a formal complaint via written claim regarding specific management actionStaff
Labor & Employee Relations
Residents and Clinical Fellows - ABC Member Claim Form Notify Blue Cross of California of any covered health service for which they have not already been billedStaff,Trainee
Benefits
Residents and Clinical Fellows - ABC Prescription Drug Reimbursement Form To be brought to the pharmacy while obtaining prescription drugsStaff,Trainee
Benefits
Residents and Clinical Fellows - Health Net Claim Form Notify Health Net of any covered health service for which they have not already been billedTrainee
Benefits
Residents and Clinical Fellows - Health Net Prescription Claim Form Reimbursement on covered medications provided by pharmaciesStaff
Benefits
Residents and Fellows New/Rehire/Renewal Form Required for new hire, rehire, or renewal processingStaff,Trainee
Appointment Maintenance
Residents and Fellows Employee Funding Worksheet Funding changesStaff,Trainee
Payroll Processing
Residents and Fellows One-Time Payment Form One-time payments and moonlighting payment requestsStaff,Trainee
Payroll Processing
FML Department Checklist May be used when an employee requests a leave of absence for medical or family care reasonsStaff
Leave Management
Employee Incident Report (EIR) Form Must be completed by employees when they sustain a work-related injury or illnessStaff
Leave Management
Supervisor Incident Report Form (SIR) Must be completed by supervisors when an employee sustains a work-related injury or illnessStaff
Leave Management
Reporting your Disability Claim Online Details when and how to report a short-term disability claim to Liberty Mutual GroupStaff
Leave Management
Pregnancy Disability Leave and Parental Leave Staff Checklist Tracking actions to take prior to going on pregnancy disability leaveStaff
Leave Management
Affiliate Request Form In conjunction with Badge/Door Access tickets for affiliates in the HR Service Request SystemAcademic,Staff
Onboarding
Job Description/Employee Requisition Form (JD/ERF) Classifying and posting new or replacement positionsStaff
Recruitment
Onboarding
Classification