Forms

HRDI Paperless Forms Launch update:  

HRDI is transitioning MyWorkplace eForms to Adobe Experience Manager (AEM) forms. Currently, Total Wellness, Compensation Services, and Payroll Services MyWorkplace eForms have been transitioned to AEM forms. Locate your desired form below and you will be directed to the new AEM portal to retrieve the form. Click here to view instructions on navigating the AEM portal. (Please note historical eForms content will remain available in MyWorkplace, any new forms will need to be created via the new AEM portal)

 

Remaining HRDI forms and their conversion go live dates will be announced later this year.

 

 

 

Search by department

 

Compensation Services

Diversity, Inclusion & Equity Programs

Labor / Employee Relations

Payroll

Risk Management

Student Employment

Talent Acquisition

Total Wellness

Academic HR Services

COMPENSATION SERVICES

 

Form

Description

10_12 / 11_12 Pay Plan

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An eligible 12-month employee can request to participate in a 10/12 or 11/12 Pay Plan based on the respective Collective Bargaining Agreement (CBA). An individual will receive an annual salary for working 10 months or 11 months, depending on the Pay Plan selected, in 12 (twelve) salary warrants. Please read your CBA or contact Human Resources Services if you have any questions.
Classification AppealPDF File Complete this form to appeal to a classification review decision (this process is only available to certain bargaining units).  Please email hrcc@fullerton.edu if there are any questions.
Personnel File Access Request (Staff & MPP)
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Human Resources, Diversity & Inclusion maintains the official personnel file for each staff member and Management Personnel Plan (MPP) employee. HRDI is responsible for protecting the privacy of all personnel files. Click on the link to complete a request form to review or request copies of your file.
Position Description (MPP)
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Position descriptions are an essential HR document that facilitates performance management, job evaluation, recruitment, organizational design and training needs, and establishes what a job is and the functions required to perform the job. Therefore, each position should have a current position description on file.
Position Description (Staff)
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Position descriptions are an essential HR document that facilitates performance management, job evaluation, recruitment, organizational design and training needs, and establishes what a job is and the functions required to perform the job. Therefore, each position should have a current position description on file.
Timebase Change
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This form is used to change employees’ percentage of hours to be worked (FTE).  Please contact HR if the request is to change other employment terms and conditions, such as responsibilities, salary...etc. Timebase changes can be initiated by management only.

Diversity, Inclusion & Equity Programs

Form

Description

DISCRIMINATION, HARASSMENT & RETALIATION

DHR Misconduct Reporting FormOpens in new window
To be used to report known or suspected incidents of discrimination, harassment, and retaliation (DHR). Submitting this form does not necessarily mean the submitter is filing a formal complaint of DHR.

ENGAGEMENT & LEARNING

Facilitator Proposal FormOpens in new window
 
Diversity, Inclusion and Equity Training RequestOpens in new window
The Engagement and Learning Unit of the Office of Diversity, Inclusion and Equity provides professional development, trainings and workshops, and leadership development in equity work for offices and departments around campus. Please fill out the form for more information on how you can bring these trainings to your office or organization.
EIP Space Available ProgramPDF File Opens in new window  

Labor / Employee Relations

Form

Description

Whistleblower Complaint FormPDF File Opens in new window  Select this form to submit a Whistleblower Complaint.
Whistleblower Retaliation Complaint FormPDF File Opens in new window  Select this form to submit a Whistleblower Retaliation Complaint.
Staff Self (Pre-Performance) Evaluation 
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 Select this form to complete a Staff Self (Pre-Performance) Evaluation
Staff Performance Evaluation Unit 1 - Physician
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 Select this form to evaluate a Unit 1 employee. 
Staff Performance Evaluation – 2,5,7,9             
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 Select this form to evaluate a Unit 2,5,7,9 employee. 
Staff Performance Evaluation Unit 4
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 Select this form to evaluate a Unit 4 employee. 
Staff Performance Evaluation Unit 6        
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  Select this form to evaluate a Unit 6 employee. 
Staff Performance Evaluation Unit 8 - Public Safety
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 Select this form to evaluate a Unit 8 employee. 
Staff Performance Evaluation - Confidential     
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 Select this form to evaluate a Confidential employee. 
MPP Employee Self Evaluation  
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 Select this form to complete a MPP Self Evaluation
MPP Performance Evaluation               
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 Select this form to evaluate a MPP employee. 
Suspected Child Abuse Report Complete the appropriate acknowledgement form on the Reporting Child Abuse and Neglect web page and submit the form electronically.

Payroll

Form

Description

Absence Management Employee Schedule ChangePDF File Opens in new window Departments can fill out this form for employees needing to change their work schedule.
Absence Management Prior Pay Period Leave AdjustmentPDF File Opens in new window Employees and/or departments can complete this form to adjust an absence entry for a prior pay period.
Beneficiary Designation Opens in new window Designation of persons, trust, estate, or corporation to receive state warrants upon death.
CD048 Manual Student Assistant Attendance
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Used when reporting a student employee’s total hours worked after the close of the pay period.
Delegation of Authority Change Request
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Used to complete/change a Payroll Services delegation of authority.
Direct Deposit (New)Opens in new window
Employees can enroll in direct deposit. View more info on Direct Deposit.
Direct Deposit (Change)Opens in new window
Employees can makes changes, or cancel direct deposit. View more info on Direct Deposit.
Dock Notice
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Used if an employee does not have enough leave credits to cover an absence, the time in excess of available leave credits must be charge to informal leave (dock). 
Duplicate Wage and Tax StatementPDF File Opens in new window
Complete this form to request a W-2 hard copy from the State Controller’s Office. View more info on W-2 Statements.
Electronic Employee Action Request FormOpens in new window
Equivalent of W-4, used for tax withholding allowance. View more info on Tax Status/Withholding Changes.
Foreign National Information (Fillable)PDF File Opens in new window All foreign nationals must complete this form before receiving payment.
Hourly Intermittent Prior Pay Period Adjustment
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Hourly Intermittent employees and/or departments can adjust hours worked for the pay period.
I9 Form - Employment Eligibility VerificationPDF File Opens in new window The Unites States and Citizenship and Immigration Services form is used to verify identity and eligibility to work. View more info on Employment Eligibility VerificationOpens in new window .
Miscellaneous Payroll Request Form 
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Used to request payment of stipends and other miscellaneous payments for eligible employees.
Notice of SeparationOpens in new window When university employees resign from their employment with CSUF or employment contracts end, they are required to complete the separation process. View more information here .

OT&SD Request Form

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Used to request payment of shift and overtime for eligible employees. 
OT&SD Request Form (Combo-New- Distributed)
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Used to request payment of shift and overtime for eligible employees when charges need to be distributed to another department or fund.
Payroll Expenditure TransferOpens in new window Departments can use this form to redistribute the funding to another accounting code - department.
Special Consultant Timesheet 2021
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Special Consultant Employees and/or departments can submit hours worked for the pay period.
STD 682 Overtime (Distributed)
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Employees and/or departments can authorize for extra hours worked by an employee in a given pay period. Overtime must be authorized before the time is actually worked. The total hours authorized must be recorded on the form and signed by the person authorized to approve overtime work.
Student Timesheets Manual Entry
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Student Employees and/or departments can submit hours worked for the pay period.
Warrants Returned to PayrollPDF File Opens in new window Departments will need to complete this form  to return pay warrants that were undeliverable to the employee.

Risk Management

Form

Description

CSU Claims Form Find a copy of this form hereOpens in new window . File a claim against the California State University or any of its campuses. 
Application of Waiver of CSU Filing Fee Find a copy of this form hereOpens in new window .  A fee waiver requesting not to pay the $25 fee to file a CSU claim.
Application for Leave to a Present a Late Claim to the CSU Find a copy of this form hereOpens in new window .  Complete this additional form if your CSU Claim form is filed more than six months after the date of the incident. 
Request for Legal Representation from the CSUOpens in new window CSU, Office of General Counsel to provide, manage and coordinate all legal services for the CSU.
Employee/Volunteer Injury/Illness ReportPDF File Opens in new window Report an employee or volunteer injury or illness related to the University.
Student or Visitor Injury/Illness ReportPDF File Opens in new window Report a student or vistor injury or illness related to the University.
Behavior Concern Report for Acts or Threats of ViolenceOpens in new window If you know of an individual that is a cause for  concern regarding their behavior or an act of violence.
Report a Hazard or LiabilityOpens in new window If you know of a hazard or liability effecting the University.
Cal State Fullerton and Assumption of Risk Waiver (COVID)PDF File Opens in new window The University will not be held liable for any injuries that an individual sustains while participating in a specific activity. Additional instructions for filling out the Release of Liability and Assumption of Risk Waiver.
COVID AcknowledgmentPDF File  
Student Code of Conduct AgreementPDF File Opens in new window Student acknowledgment to follow rules and regulations of the CSU and University while participating in off campus events.
Request for Foreign Travel Liability InsuranceOpens in new window Foreign Travel Liability Insurance Program is designed to provide financial protection for both trip participants and the University for claims arising from sponsored foreign travel.
University Field Trip Emergency Participant RosterOpens in new window Completed prior to off campus activity providing student emergency contact information.
Email a copy to risk@fullerton.edu
INF 254 – Request for Driver’s License InformationPDF File Opens in new window Driving on University business, you must complete and submit one original form with your signature ten (10) business days prior to driving. Send to University Police Department.
STD 261 – Authorization to Use Privately Owned Vehicles on State BusinessPDF File Opens in new window Requesting to use privately owned vehicles to conduct official State business. Original form stays within department.
STD 270 - State Driver Accident Report Form Download and complete STD 270 or 274 form.Opens in new window  Go to section-Automobile and General Liability Claims. Complete form and send to Risk Management in CP-770 within 48 hours of the vehicle accidentSend to Risk Management Department CP-770 within 48 hours after accident. 
STD 274 - State Driver Accident Review Form - Supervisor Review Form Download and complete STD 270 or 274 form.Opens in new window  Go to section-Automobile and General Liability Claims. Complete form and send to Risk Management in CP-770 within 48 hours of the vehicle accidentSend to Risk Management Department CP-770 within 48 hours after accident. 
Cal State Fullerton - Volunteer FormPDF File Opens in new window Any individual volunteering for the University must complete this form and have approved prior to commencing service.
Cal State Fullerton - Minors - Volunteer Release FormPDF File Opens in new window To be completed and signed by parent or guardian if volunteer is a minor under 18 years of age.
Cal State Fullerton - Volunteer Safety Briefing FormPDF File Opens in new window General campus safety and emergency preparedness.

Student Employment

Form

Description

Alternate Student Assistant Manual FormPDF File Opens in new window
May be used to hire a Student Assistant that has graduated and is no longer active within CMS.
Federal Work Study Position Description TemplatePDF File Opens in new window
To be shared with Federal Work-Study within Financial Aid for approval of the position, and to provide department contact information.
Student Assistant Pre-Performance Evaluation (Student)PDF File Opens in new window
A self-evaluation for Student Assistants that can be utilized as a tool by employers.
Student Assistant Performance Evaluation (Supervisor)PDF File Opens in new window
The supervisor’s version of the performance evaluation. Evaluations are recommended during the first semester of work, and annually thereafter.
Student Task Profile Action FormPDF File Opens in new window
Complete this form to create, change or inactivate Student Task Profiles. If you have specific questions on the use or set up of Task Profiles, your Division Finance Coordinator or College Budget Analyst are good resources.

Talent Acquisition

Form

Description

Position Action FormPDF File Opens in new window
Complete this form to request the creation of positions, position data changes and split funding costs in CMS. 
For multiple position changes such as funding, etc., please complete the top section of the Position Action Form, and under comments, please indicate “see attached”. Submit an excel spreadsheet with the position updates along with your signed Position Action Form to Position Management at prpm@fullerton.edu.
Student Task Profile Action FormPDF File Opens in new window
Complete this form to create, change or inactivate Student Task Profiles. If you have specific questions on the use or set up of Task Profiles, your Division Finance Coordinator or College Budget Analyst are good resources.
Temporary Service Authorization FormPDF File Opens in new window
The Service Authorization allows department funds to be allocated to an open blanket Purchase Order blanket for either staffing agency.

Total Wellness

Form

Description

ADA/Disability Accomodations

Americans with Disabilities - Certification of Healthcare ProviderPDF File Opens in new window
Request by Fair Employment and Housing and ADA for Certification of Disability by Health Care Provider.
Complaint form for Discrimination/Harassment/Retaliation Complaints
Executive Order 1096 Complaint Form for Discrimination/Harassment/Retaliation Complaints.
Disability Accommodations Medical Release FormPDF File Opens in new window
Used by employee to clarify work restrictions and to obtain timelines for requested reasonable accommodation(s). It is not a release for medical information.
Medical Inquiry Form in Response to an Accommodation Request PDF File Opens in new window
Used by Physician/Medical Provider to help determine whether an employee has a disability under the ADA.
Request for Disability Accommodations FormPDF File Opens in new window Used to request a disability accommodation.

Benefits

Benefits Enrollment/Change WorksheetPDF File Opens in new window
Used to initiate enrollment or make changes to your health benefits. 
Benefits Self-Service Electronic Signature AuthorizationPDF File Opens in new window
Used by employee to authorize the campus Benefits Office to accept manual benefit enrollment/change requests.
Health Premium Deduction AuthorizationPDF File
Used by employees to authorize payroll deduction.
Affidavit of Parent-Child RelationshipPDF File Used by employee to enroll a child, other than an adopted, step or recognized natural child, for whom the employee has assumed a “parent-child relationship” with that child in lieu of the child's adoptive, step or natural parent, up to age 26.
Career Development Plan
Access AEM FormOpens in new window
Used in conjunction with the Employee Fee Waiver Program when pursuing a degree.
Dependent Fee Waiver Program Application
Access AEM FormOpens in new window
Dependent fee waiver application form.
Domestic Partner Certification Form
Access AEM FormOpens in new window
Used by employee to determine imputed tax liability status for domestic partnership (DP) health-related benefits.
Employee Fee Waiver Application
Access AEM FormOpens in new window
Employee fee waiver application form. 
Short Application For Employee Fee Waiver
Access AEM FormOpens in new window
Application for job-related courses only.

Leaves

Catastrophic Leave Request 
Access AEM FormOpens in new window                          
Request for Solicitation of Donated Leave Credits and Hold Harmless Form.
Catastrophic Leave Donation 
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Donation of leave credits or sick leave by one employee to another.
Request for Expanded COVID-19 Relief Leave (ECRL) PDF File
Used to request ECRL (Expanded COVID Related Leave). 
Request for Formal Leave of AbsencePDF File Opens in new window
Used by employee to request a formal leave of absence.

Retirement

Emeritus Request Form FacultyPDF File Opens in new window
Emeritus request/nomination form for faculty members. Submit completed form to hr@fullerton.edu
 
Emeritus Request Form StaffPDF File Opens in new window
Emeritus request/nomination form for staff, management and adminstrators.  Submit completed form to  hr@fullerton.edu

Workers' Compensation

Departmental W.C. Posting Notice (Fullerton)PDF File Opens in new window
State of California-Industrial Relations- Division of Workers' Compensation required posting notice.
Departmental W.C. Posting Notice (Irvine)PDF File Opens in new window
State of California-Industrial Relations- Division of Workers' Compensation required posting notice.
Employee/Volunteer Injury/Illness ReportPDF File Opens in new window
Used to report an injury or illness.
Employee’s Claim for Workers’ Compensation Benefits (DWC-1)PDF File Opens in new window
Used to file a workers’ compensation claim with your employer. Used when the injury or illness requires  more than first aid.
First Fill Prescription Form (optum) PDF File Opens in new window
Workers' Compensation prescription drug program for injury related prescriptions.
Fullerton Campus (Brea Urgent Care)PDF File Opens in new window
Used at Fullerton main campus to authorize treatment at Brea Urgent Care.
Guidelines for Contact with Employees Off Work Due to an Injury or IllnessPDF File Opens in new window
Return-to-Work Guidelines for supervisors when employee is off work.
Sand Canyon Urgent CarePDF File Opens in new window
Used at Irvine campus to authorize treatment at Sand Canyon Urgent Care Medical Center.
Saddleback Family and Urgent Care PDF File Opens in new window
Used at Irvine campus to authorize treatment at Saddleback Family and Urgent Care.
Notice of Personal Chiropractor or Personal AcupuncturistPDF File Opens in new window
Used to designate personal chiropractor or acupuncturist.
Physician Pre-DesignationPDF File Opens in new window
Used to pre-designate personal physician.
Student/Visitor Injury FormPDF File
To be used by students that are injured in class or on a field trip. Not for students working as a volunteer or student assistant during the incident.

 

ACADEMIC HR SERVICES

FORM

DESCRIPTION

Chair-Director Appointment FormPDF File Opens in new window
Form for department to appoint Chair/ Director.
CSU1 FormOpens in new window
Statement of Professional Preparation and Experience application.
Degree & Background Release FormPDF File Opens in new window
Form to authorize the University to perform verification and background reference checks.
Faculty Action Request Form InstructionsPDF File Opens in new window
The Faculty Action Request (FAR) form is to be used in the event an appointment correction is necessary for an existing temporary faculty, graduate assistant, teaching associate, or instructional student assistant.
Faculty Additional Employment Request Form
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Form to process faculty additional work (2403, 2359, and 4660-Summer). 
Faculty Early Retirement Program Request FormPDF File
This form is to be used by faculty to request participation in the Faculty Early Retirement Program (FERP) or to request a change in FERP status.
Full Time Lecturer Hiring Doc Checklist - No SearchPDF File Opens in new window
Form Required for Full-Time Lecturer appointment packet if previously employed Full-Time and no search was conducted.
Full Time Lecturer Hiring Doc Checklist - SearchPDF File Opens in new window
Form Required for Full-Time Lecturer appointment packet if previously employed Full-Time and a search was conducted.
Missing Hiring Documentation Waiver FormPDF File Opens in new window
Form required to be completed if there are any missing documents from the appointment packet.
Pre-Retirement Reduction in Time Base FormPDF File Opens in new window
This form is to be used by faculty to request participation in Pre-Retirement Reduction in Time Base (PRTB) or to request a change in PRTB status.
Substitute Faculty Appointment for Short Duration FormPDF File Opens in new window
Substitute Faculty Appointment form with estimated hours worksheet.
Substitute Faculty Time SheetPDF File Opens in new window
Faculty record their lectured hours as well as the hours spent in labs/or activity for each day worked.
TA Substitute Appointment FormPDF File
Teaching Associate Substitute appointment form with timesheet.
Tenure Track Hiring with Service Credit Documentation ChecklistPDF File Opens in new window
Checklist to be completed for full time tenure track appointments receiving service credit.
Tenure Track Hiring Documentation ChecklistPDF File Opens in new window
Checklist to be completed for full time tenure track appointments. 
Unit 11 Performance Evaluation FormPDF File Opens in new window
Performance evaluation form for all Unit 11 employee (Graduate Assistants, Instructional Student Assistants, Teaching Associates).
Visiting Faculty Hiring Documentation ChecklistPDF File Opens in new window
Checklist to be completed for all visiting faculty appointments.