Human Resources Alphanumerical Form Index

The Human Resources Forms Directory has moved to a new location:

http://www-admn.csun.edu/ohrs/atozforms.htm

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Form

Title

Purpose/Use

Formats Available

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PA 634
(02/2004)

Absence Report

Used internally by campus departments to report leave usage.

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(07/2007)

Action Request Form
(Combines 3-in-1, Change in Status , Emergency/ Limited-Term Appointment Form, and Recruitment Requisition Form)

This form is used to request changes to the current employment status of an employee; request a limited-term temporary appointment to a position vacancy for which recruitment is not required;and to initiate recruitment to fill all vacant state positions with the exception of student assistant, work-study student, graduate assistant, and positions in Unit 3. INSTRUCTIONS FOR THIS FORM

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OHRS 20-54
(12/2000)

Applicant Interview Evaluation Record
(Formerly Search Form: Interview Evaluation Record)

Used to list criteria for evaluating interviewed candidates during a search.

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OHRS 20-5
(11/2001)

Applicant Selection Form
(Formerly Search Form: Applicant Selection & Disposition Form)

Used to convey final selection after completion of interviews in a search.

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OHRS 20-55
(12/2000)

Application Screening Record
(Formerly Search Form: Application Screening Record)

Used to list criteria for screening applications during a search.

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OHRS 20-58
(03/2007)

Authorization for Moving and Relocation Expense Reimbursement

Used by departments to authorize moving and relocation reimbursement for administrators, staff, and faculty.

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N/A
(1/2007)

Benefits Worksheet

Used for enrollment in Health/Dental/HCRA/DCRA benefits.

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OHRS 1-8
(12/2003)

Catastrophic Leave Donation Form
(Formerly Pledge for Donation of Leave for Catastrophic Illness)

Donations of sick or vacation leave to employees of CSUN who are eligible for catastrophic leave.

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OHRS 30-79
(04/2004)

Catastrophic Leave Donation Program

Used to request participation in the Catastrophic Leave Donation Program.

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OHRS 20-37
(07/2007)

Change in Status Form
(Now Action Request Form)

This form may be used to request changes to the current employment status of an employee and may be initiated by an employee or supervisor. INSTRUCTIONS FOR THIS FORM

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OHRS 10-2
(11/2004)

Classification Appeal
(Formerly Employee's Notice of Classification Appeal)

Used to request a classification appeal.

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OHRS 50-15
(07/2004)

Confidentiality Agreement - Faculty
(Formerly Employee Confidentiality Statement - Faculty)

Use this form for faculty employee access to University data systems containing personal, academic, or financial information about students, faculty, staff, or alumni.

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OHRS 50-4
(07/2004)

Confidentiality Agreement
(Formerly Employee Confidentiality Statement)

Use this form for employee access to University data systems containing personal, academic, or financial information about students, faculty, staff, or alumni.

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DELTA 105
Rev. 7/03

Delta Dental DPO Claim Form

Used for dental services rendered. Form is to be taken to dental office for completion.

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STD 699
(REV. 7-2000)

Direct Deposit Enrollment Authorization
Direct Deposit Contract

Used to enroll in or change direct deposit of pay warrants (return with signature to Payroll Administration, University Hall Room 185; questions, call x2314). Link to form takes you to State of California forms website.

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OHRS 20-20
(07/2007)

Emergency/Limited-Term Appointment Form
(Now Action Request Form)

This form is used when requesting a limited-term temporary appointment to a position vacancy for which recruitment is not required. INSTRUCTIONS FOR THIS FORM

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STD 686
(Rev. 12/2004)

Employee Action Request/Change Form
(Formerly Federal/State Withholding and/or Address Change Form - (FACULTY/STAFF/MANAGEMENT EMPLOYEE ONLY))

Employee Action Request Form is used to make changes to Federal and State Withholding and/or address changes. Remit completed form to HRIS/Payroll Administration, UN-185 with original signature and date. No photocopies accepted. Link to form takes you to State of California forms website.

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OHRS 30-72
(08/1999)

Employee Information Change Form - State
(Formerly State Employee Information Form (S.E.I.F.))

Use for employee information changes such as address, telephone number, etc. Instructions are included with this form.

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N/A
(04/2006)

Employment Application
(Formerly Application for Employment)

Use this form to apply for employment at California State University, Northridge.

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PA 125
(04/2004)

Extra Hours Worked, Authorization
(Formerly Authorization for Extra Hours Worked)

Used by campus employees to document their overtime, CTO, or straight time worked in excess of their regular schedule.

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OHRS-PS
C-60-6
(08/2005)

Extra Hours Worked, Control Log CTO
(Formerly Authorization for Extra Hours Worked - Control Log (CTO Credits))

Monthly control log used to summarize all of the CTO (Compensatory Time Off) credits earned by employees. Must be submitted with "Authorization for Extra Hours Worked" sheet(s).
INSTRUCTIONS FOR THIS FORM

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OHRS-PS
C-60-5
(08/2005)

Extra Hours Worked, Control Log Straight Time
(Formerly Authorization for Extra Hours Worked - Control Log (Straight Time))

Monthly control log used to summarize all of the overtime/straight time cash payments due to employees. Must be submitted with "Authorization for Extra Hours Worked" sheet(s).
INSTRUCTIONS FOR THIS FORM

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OHRS 20-54
(12/2000)

Interview Evaluation Record (Search Form)

Used to list criteria for evaluating interviewed candidates during a search.

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OHRS 20-62
(01/2004)

Justification for Initiation of Search or Certain Personnel Appointments/ Actions in the General Fund for Academic Affairs

This form is to be completed and attached to the Personnel Requisition for all requests to initiate a search for management, probationary, and temporary renewable staff appointments; and extensions of temporary renewable appointments of six months or more in the General Fund for Academic Affairs.

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OHRS 20-62
(01/2004)

Justification for Recruitment of Vacant Position
(Formerly Search Form: Justification for Initiation of Search)

This form is to be completed and attached to the Personnel Requisition for all requests to initiate a search for management and probationary staff appointments in the General Fund.

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(07/2007)

Leave of Absence Request Form

This form is used to request a Leave of Absence or request to return to work from a leave.

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MPC Form
(1/04/06)

Master Payroll Certification (MPC) Exception Form

Use this form to report monthly master payroll transactions missed during the regular MPC cycle.

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OHRS 20-56
(04/2005)

New Employee Sign-In Form

Used for new employee sign in.

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STD 435
(REV. 9-2000c)

Pay Warrant Replacement - Lost/Stolen
(Formerly Lost or Stolen Pay Warrant -
Request for Duplicate Controller's Warrant / Stop Payment)

Used by employees to request a duplicate pay warrant / stop payment (return with Signature to Payroll Administration, University Hall Room 185, questions, call x2314). Link to form takes you to State of California forms website.

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OHRS 50-12
(04/2005)

SOLAR HRMS Access Request Form
(Formerly Application for Individual Access to SOLAR HRMS)

Use this form to request access to the HR system for an individual employee.

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N/A

Performance Evaluation Form - MPP Performance Review and Assessment Tool

Used to evaluate MPP administrators and supervisors. NEW FORM

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OHRS 20-49
(12/2005)

Performance Evaluation Form (Unit 4)
(Formerly Performance Evaluation Form for Unit 4)

Used to evaluate performances for employees within Unit 4.

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OHRS 30-11
(08/2002)

Performance Review
(Formerly Report of Employee Performance)

Used to evaluate all support staff (instructions included with form).

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N/A

Personnel Action Request Form - Faculty
(Formerly Faculty Personnel Action Request Form)

Used for faculty personnel action request.

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OHRS 50-14
(05/2005)

Portal Access for NEW Special Pay Faculty
(Formerly New Faculty Notice - Portal Access for Special Pay Faculty)

Used to activate CSUN ID for access to the portal.

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OHRS 1-9
(02/2003)

Position Description - MPP
(Formerly MPP Performance Program)

Used to develop the Performance Program for MPP positions.

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OHRS 10-09
(11/2004)

Position Description Form

Use this form to provide the employee with a written description of the duties for which he or she is responsible. This form replaces OHRS 10-06, 10-10, and the Position Analysis/Description Questionnaire (for I.T. Positions)

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OHRS TUC 10-11
(04/2005)

Position Description Form - Auxiliary
(Formerly The University Corporation Position Description Form)

Use this form to provide the employee with a written description of the duties for which he or she is responsible.

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PA 115
(08/2005)

Prior Pay Period Adjustment Form

Used by campus departments to request adjustments to an employee's pay and/or leave balance, including sick leave, CTO, and vacation usage from a prior pay period. DO NOT USE THIS FORM FOR WORK-STUDY PRIOR PAY PERIOD ADJUSTMENTS.

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OHRS-PS
C-60-10
(11/2003)

Prior Pay Period Adjustment Form - Work-Study
(Formerly Work-Study Payroll Adjustment Form)

Summary to report miscellaneous adjustments to Work-Study Payroll, including hours from a prior pay period. Use for on and off campus Work-Study. (Instructions included with form)

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OHRS TUC-Req
(04/2005)

Recruitment Requisition Form - Auxiliary
(Formerly The University Corporation Recruitment Requisition Form)

The Recruitment Requisition Form is used to initiate recruitment to fill vacant positions for which recruitment is required. (Not for use when filling state reimbursed or summer workshop positions.)

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OHRS 20-15
(07/2007)

Recruitment Requisition Form
(Now Action Request Form)

The Personnel Requisition Form is used to initiate recruitment to fill all vacant state positions with the exception of student assistant, work-study student, graduate assistant, and positions in Unit 3. INSTRUCTIONS FOR THIS FORM

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OHRS 10-16
(02/2004)

Reduced Worktime Program Request
(Formerly Request for Participation Reduced Worktime Program)

Used for requesting participation in the Reduced Worktime Program.

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OHRS 20-65
(03/2005)

Relocation Declaration of Reimbursement
(Formerly Declaration of Notice - Repayment of Moving or Relocation Reimbursement)

Used to acknowledge compliance with conditions under which moving and relocation expenses shall be repaid.

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DC-3500-0105

Retirement (Part-Time, Seasonal, Temporary) Distribution Form
(Formerly PST Retirement Plan Benefit Payment Application)

Used to request payment of PST retirement funds after retirement or separation from State employment.

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PERS-BSD-369-S

Retirement Application for CalPERS
(Formerly Application for Service Retirement)

Used by members of CalPERS to apply for service retirement.

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Revised 01/2006

Salary Reduction Form/Tax-Sheltered Annuity Salary Reduction Agreement
(Formerly CSU Salary Reduction Agreement Form)

Used when enrolling and/or making a change to a 403(b) Tax-sheltered Annuity plan.

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OHRS 20-5
(11/2001)

Selection Form
(Formerly Applicant Selection and Disposition)

Used to convey final selection after completion of interviews in a search.

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OHRS 30-73

Separation/Clearance Designee Election Form
(Formerly Faculty and Staff Separation/Clearance Designee Election Form)

Used to designate an employee responsible for completing all department separation/clearance processes.

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OHRS 30-23
(03/2004)

Separation/Clearance Form
(Formerly Faculty and Staff Separation/Clearance Form)

For all faculty and staff who are separating employment from CSUN. Full and part-time faculty members who are expected to return during the following semester may be exempt from this process, at the discretion of the Dean of the College.

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C-60-16
(OHRS-PS)
(02/2004)

Signature Authorization, Payroll Documents
(Formerly Authorized Signature for Payroll Documents)

Used by campus departments to notify HRIS/Payroll Administration of persons authorized to sign payroll documents.

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PA 120
(03/2005)

Special Pay Authorization
(Formerly Authorization for Special Pay)

Used by campus departments to request payments for hours, units, or days worked on projects falling under the "Special Pay" classifications.
INSTRUCTIONS FOR THIS FORM

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STD 457
(Rev 9/2004)

Student Action Request/Change Form
(Formerly Federal/State Withholding and/or Address Change Form - (STUDENT EMPLOYEE ONLY))

CSU Student Payroll Action Request Form is used to make changes to Federal and State Withholding and/or address changes. Remit completed form to HRIS/Payroll Administration, UN-185 with original signature and date. No photocopies accepted. Link to form takes you to State of California forms website.

OHRS PS
C-60-1
(08/2005)

Student Assistant Payroll Summary

Monthly payroll summary for Student Assistant workers in campus departments. Will accommodate up to 25 students.
INSTRUCTIONS FOR THIS FORM

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OHRS 20-60
(10/2001)

Student Assistant Hire Form

Use this form to document the hire of a new Student Assistant.

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OHRS 20-57
(10/2001)

Student Employee Job Data Change Form

This form is used to document and authorize requests for additional appointment or change to the current employment status of a student assistant or work-study student.

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PA 110
(08/2005)

Summer Session YRO Pay, Authorization
(Formerly Authorization for Y.R.O. Summer Session Pay)

Used by campus departments to request payments for faculty involved in the year-round operations.

PA 130
(06/2005)

Summer Session, 1/30th Pay Rate
(Formerly Summer Term, 1/30th Pay Rate)

Used by campus departments to report summer session pay for faculty that worked the previous fall or spring.

PA 135
(06/2005)

Summer Session, 2357 Salary Schedule
(Formerly Summer Term, 2357 Salary Schedule)

Used by campus departments to report faculty teaching summer only.

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PA 100
(01/2002)

Timesheet
(Formerly Campus Timesheet)

Used by Student Assistant, Work-Study, and Hourly employees to track their hours worked.

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N/A
(07/2002)

Transfer of Leave Balance from Position to Position, Authorization
(Formerly Authorization for Transfer of Leave Balance from Position to Position)

When an employee has multiple positions and is earning vacation or sick leave in more than one job, the employee may transfer hours between positions. This transfer is allowed when there is an insufficient balance in the second position and the employee needs a specific amount to cover a time off for a specific time period.