Benefits The benefits office is currently in the process of creating online forms for the web. They will be adding forms regularly. If you need a form you see listed here without a corresponding link, please contact the benefits office for a printed copy at (916) 278-6213.
| Title/Purpose | MS |
PDF |
Web |
Affidavit of Eligibility for Economically
Dependent Children |
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Affidavit of Marriage |
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CALPERS Beneficiary Designation Form |
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CALPERS Declaration of Health Coverage
HB-12A |
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Change of Plan Worksheet |
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COBRA Information & Rights |
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COBRA Frequently Asked Questions |
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COBRA Notice to New Enrollee and/or Eligibility
Dependents |
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COBRA Premium Rate Chart |
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Continuation of Coverage Handout |
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CSU Benefits in Brief for Legislative
Fellows |
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Dependent Care Reimbursement Account |
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Defined Contribution Plan Distribution
Kit |
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Delta Dental Claim Form |
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Domestic Partner Dependent Certification
Form |
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Domestic Partner's Tax Implication |
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Family Care and Medical Leave Employee
Application |
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FERP Summary
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Frequently Asked Questions - Faculty |
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Frequently Asked Questions - Staff/MPP |
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Health Care Reimbursement Account |
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Health/Dental/Vision New Hire Worksheet |
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Health Monthly Rate
Chart & PERS
Health Benefits Plan Rate |
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HIPAA Authorization Form |
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Long Term Disability Certificate |
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Notice of Intent to Retire - Faculty |
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Notice of Intent to Retire - Staff/MPP |
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Open Enrollment Worksheet |
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Part-Time, Seasonal or Temporary (PST)
Retirement Plan Benefit Payment Application |
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Salary Reduction Agreement (Contact Benefits Office) |
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Standard Insurance Beneficiary Designation
form for the State Paid Life Insurance |
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Standard Insurance Beneficiary Designation
form for Voluntary Life Insurance |
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Statement of Financial Liability for
Domestic Partner for Dental/Vision Benefits |
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Statement of Financial Liability - Domestic
Partner - Health |
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Vision Service Plan VDT Claim Form |
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| updated 11/02/09 | |||
Title/Purpose |
MS |
PDF |
Web |
Appeals Form |
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Check-List for All Classification/Skill
Level Requests |
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Position Description - General Positions (Updated) |
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Position Description - Information Technology (Updated) |
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Request for In-Range Progression |
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Request for Performance-Based In-Range Progression |
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Request for Staff Bonus |
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Request for Staff Promotion (On-Campus)
Above Minimum |
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Request for Staff Appointment (Off-Campus)
Above Minimum |
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Equal Opportunity/Affirmative Action
Title/Purpose |
MS |
PDF |
Web |
Applicant Flow Questionnaire |
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Appointment Process Summary |
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Assistive Device Application Form |
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Disability Survey |
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Employee Disability Accommodation Form |
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Part-Time Pool |
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Protected Disclosure Complaint Form |
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Faculty/Management Employment Forms
Title/Purpose |
MS |
PDF |
Web |
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Appointment Process Summary |
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Courses Taught at other CSU Campuses
or other Departments at CSUS |
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Difference-In-Pay (DIP) Application |
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Difference-In-Pay (DIP) Final Report |
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Faculty Interviewee Information Form |
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Faculty Leave Without Pay |
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Market Salary Increase Form |
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Personnel Transaction Form |
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Planning and Performance Evaluation Form
for Administrators I-IV |
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Request for Exemption Form |
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Request to Advertise - Full Time Faculty |
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Request to Hire Staff/MPP Retired Annuitant |
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Recommendation for Employment of a Substitute |
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Sabbatical Leave Application |
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Sabbatical Leave Final Report |
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Special Consultant Checklist |
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Special Consultant Agreement |
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Special Consultant Timesheet |
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Voluntary Resignation |
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Title/Purpose |
MS |
PDF |
Web |
Absence Request (Timesheet) |
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Absence Without Pay Report (Dock) |
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Authorization for Extra Hours |
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Check-Out and Clearance
Form - Staff & Full-Time
Faculty |
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Check-Out and Clearance Form - Part-Time
Faculty |
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CSU Student Payroll Action Request |
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Direct Deposit |
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Employee Action Request |
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I-9 Instructions & Form |
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Request for Duplicate Warrant |
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Student Employment Payroll Transaction |
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Volunteer Identification Form |
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Student
Timesheets |
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FWS Student Timesheet |
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Non-Resident/Bridge Student Timesheet |
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Student Timesheet |
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Professional Development/Training
Title/Purpose |
MS |
PDF |
Web |
Certificate of Eligibility |
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Title/Purpose |
MS |
PDF |
Web |
| Casual Worker and Helper/Aid Request Form | |
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Hourly Intermittent Report of Performance |
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IT Performance Report |
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IT Position Description |
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Leave Of Absence Without Pay Request
Form |
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Performance Evaluation
Information & Instructions |
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Personnel Transaction Form |
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Position Description Form (Updated) |
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Process Summary Form |
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Request for Exemption Form |
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Request for Staff Promotion (On-Campus)
Above Minimum |
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Request for Staff Appointment (Off-Campus)
Above Minimum |
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Request for Temporary Agency Employee |
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Request for Temporary, 90-day Employee |
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Request to Hire Staff/MPP Retired Annuitant |
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Staff Performance Evaluation Form |
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Temporary Staff Application Form |
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Unit 4 Performance Evaluation Form |
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Unit 1 Job Performance Standards |
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Voluntary Resignation |
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Workers' Compensation & Disability Leaves The Disability Leaves office is currently in the process of creating online forms for the web. They will be adding forms regularly. If you need a form you see listed here without a corresponding link, please contact the Disability Leaves office for a printed copy at (916) 278-3522.
Title/Purpose |
MS |
PDF |
Web |
Benefit Option Selection Form |
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Catastrophic Leave Donor Form |
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Checklist for Workers' Compensation |
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Employee's Claim for Workers' Compensation
Benefits |
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Injuries on the Job Poster |
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Family Medical Leave Act of 1993 |
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Leave Of Absence Without Pay Request
Form |
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Maternity/Paternity/Adoption Leave |
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Program Overview |
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Physicians - Unit 1 (UAPD) |
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CSUEU Support Services - Units 2, 5, 7 & 9 |
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Faculty - Unit 3 (CFA) |
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Academic Support - Unit 4 (APC) |
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Skilled Crafts - Unit 6 |
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Public Safety - Unit 8 |
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Management Personnel Plan (MPP) |
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Request for Paternity/Maternity Leave |
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NDI Overview |
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Pre-Designation of Personal Physician |
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Report of Incident or Accident |
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Transitional Employment Brochure - Welcome |
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Work Status Form |
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Workers' Compensation Industrial Disability
Leave Brochure |
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