Forms

Forms

Employee-initiated Reduction In Time (ERIT) Contract - 7/1/12–6/30/14

Individual Development Plan Form

Membership Application - Emeriti Association

Membership Application - Retirees Assocation

Tax Withholding Election for UCRP Income

ASAP

Notice of Privacy Practices

Benefits

Notice to UC of a COBRA Qualifying Event (UBEN 109)

Reduced Fee Enrollment Application

Compensation

Analyst Questionnaire

Business Officer/MSO Questionnaire

CNT Information Systems & Software Engineer Questionnaire

CNT Information Systems and Software Engineer Matrix

CNT Systems & Network Administrators Questionnaire

Contracts and Grant Questionnaire

CX/Teamsters Time Election Form

Employee Flex Schedule Agreement Form

Employee Self-Assessment Form

Graduate Advisor Questionnaire

HX/UPTE Comp Time Election Form

Job Description Template

Non-Exempt Non-Represented Election Form

NX/CNCANomp Time Election Form

Performance Eval Form - Non-Represented Staff (Type-In) Version_2017 for Mac

Performance Eval Form - Non-Represented Staff (Type-In) Version_2017 for Windows

Performance Eval Form - Non-Represented Staff (Type-In, No Drop-Downs) Version_2017

Performance Eval Form Represented Employee

Probationary Period Report Form

RX/UPTE Comp Time Election Form

SAO Questionnaire

SX/AFSCME Comp Time Election Form

TX/UPTE Comp Time Election Form

Undergraduate Advisor Questionnaire

Vacation Policy Request for Exception Form

Employee Services

Employee Request for Reasonable Accommodation

Medical Response for a Reasonable Accommodation Request

Medical Response for Reasonable Accommodation - ESA

Reasonable Accommodation Agreement

Transitional Work Program Agreement

Work Status Form

Employment

Above 25% Increase for Employment at the Minimum of the Salary Range Request Form

Above Midpoint Hire Request Form

Fingerprint Authorization Form A

Background Check Authorization to Release Information Form - Form C

CANRA Acknowledgement Form

Cybersecurity Checklist

DMV Employer Pull Notice Program - Employee Notice

DMV Employer Pull Notice Program - Enroll/Delete Form

DMV Employer Pull Notice Program - Notice of Point Assignment

Dual Employment Request Form

Employee Agreement- University Purchased Equipment

Employee Flex Schedule Agreement Form

Employment Contract Amendment Template (ATHL only)

Employment Contract Amendment Template Revise End Date (ATHL only)

Employment Contract Template - Amendment

Employment Contract Template - Development Officer

Employment Contract Template - MSP Coach

Employment Contract Template - MSP General Use

Employment Contract Template - PSS Coach (Non-Exempt)

Employment Contract - PSS Coach (Exempt)

Employment Contract Template - PSS General Use (Exempt)

Employment Contract Template - PSS General Use (Non-Exempt)

Employment of a Near Relative Request Form

Employment of a Near Relative Request Form - VCAD only

Fingerprint Authorization Form A (Editable)

Home Office Checklist

Job Description Template

List of Mandated Reporters with Signed Certifications Report

New Hire Checklist

Overtime Pay Instructions for Dual Employment

Probationary Period Report Form

UBEN 1039-Reemployed Retiree Notification Form

Retention of Near Relatives Request Form - VCAD only

Retention of Near Relative Employees Request Form

Retired Employees Approval Form

Statement Acknowledging Requirement to Report Child Abuse

Telecommute - Remote Work Agreement

Telephone Reference Check

Temporary Intercampus or Multicampus Appointment Form (UPAY 560-T)

UCSB Home Safety Checklist for Telecommuters and Remote Workers

UCSB Remote Worker Agreement Template

UCSB Supervisor's Checklist for Telecommuters and Remote Workers

UCSB Telecommuter Agreement Template

UCSB Receipt of University Equipment

Voluntary Self-Identification of Disability Form (Form CC305)

Voluntary Self-Identification of Race, Ethnicity and Veteran Status Form (U5605)

Waiver of Open Recruitment Request Form

Leave of Absence

Catastrophic Leave Donation Form

Catastrophic Leave Request Form

Certificate of Health Care Provider for Employee’s Pregnancy Disability

Certificate of Health Care Provider for Employee’s Serious Health Condition

Certificate of Health Care Provider for Family Member’s Serious Health Condition

Certificate of Healthcare Provider non-FML

Certification for Military Caregiver Leave

Certification for Qualifying Exigency Leave

Declaration of Relationship

Declaration of Relationship non-FML

Designation Notice

FML Exempt Employee Workweek Agreement

FML Usage Tracking Calculator

Leave of Absence Request form

Liberty Mutual Attending Physician's Statement

Liberty Mutual Department Statement

Liberty Mutual Disability Claim Form

Liberty Mutual Disability Claim Form - Spanish

Liberty Mutual Reporting Your Disability Claim Online

Notice of Eligibility and Rights & Responsibilities

Return to Work Certification

Return to Work Certification non-FML

Training

Dilling Yang Staff Scholarship Application Form with Guidelines

Dilling Yang Staff Scholarship Evaluation Form