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)
Search by department
COMPENSATION SERVICES
Form |
Description |
|---|---|
|
10_12 / 11_12 Pay Plan Access AEM Form
|
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 Appeal
|
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. |
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Personnel File Access Request (Staff & MPP)
|
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. |
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Position Description (MPP)
|
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. |
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Position Description (Staff)
|
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
|
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 Form
|
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 |
|
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Facilitator Proposal Form
|
For individuals on campus who are interested in expanding learning opportunities in diversity and inclusion and leadership development offered by our office. Use this form to submit your workshops, trainings, seminars, assessments, etc. to add to our list of potential offerings. |
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Diversity, Inclusion and Equity Training Request
|
Request 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. |
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EIP Space Available Program
|
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Labor / Employee Relations
Form |
Description |
|---|---|
|
Whistleblower Complaint Form
|
Select this form to submit a Whistleblower Complaint. |
|
Whistleblower Retaliation Complaint Form
|
Select this form to submit a Whistleblower Retaliation Complaint. |
| Staff Self (Pre-Performance) Evaluation Access AEM Form |
Select this form to complete a Staff Self (Pre-Performance) Evaluation |
| Staff Performance Evaluation Unit 1 - Physician Access AEM Form |
Select this form to evaluate a Unit 1 employee. |
| Staff Performance Evaluation – 2,5,7,9 Access AEM Form |
Select this form to evaluate a Unit 2,5,7,9 employee. |
| Staff Performance Evaluation Unit 4 Access AEM Form |
Select this form to evaluate a Unit 4 employee. |
| Staff Performance Evaluation Unit 6 Access AEM Form |
Select this form to evaluate a Unit 6 employee. |
| Staff Performance Evaluation Unit 8 - Public Safety Access AEM Form |
Select this form to evaluate a Unit 8 employee. |
| Staff Performance Evaluation - Confidential Access AEM Form |
Select this form to evaluate a Confidential employee. |
| MPP Employee Self Evaluation Access AEM Form |
Select this form to complete a MPP Self Evaluation |
| MPP Performance Evaluation Access AEM Form |
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 Change
|
Departments can fill out this form for employees needing to change their work schedule. |
|
Absence Management Prior Pay Period Leave Adjustment
|
Employees and/or departments can complete this form to adjust an absence entry for a prior pay period. |
|
Beneficiary Designation
|
Designation of persons, trust, estate, or corporation to receive state warrants upon death. |
| CD048 Manual Student Assistant Attendance Access AEM Form |
Used when reporting a student employee’s total hours worked after the close of the pay period. |
| Delegation of Authority Change Request Access AEM Form |
Used to complete/change a Payroll Services delegation of authority. |
| Direct Deposit |
Contact Payroll Services at
Payroll@Fullerton.edu
from your campus email account to request the direct deposit form.
|
| Dock Notice Access AEM Form |
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 Statement
|
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 Form | Equivalent of W-4, used for tax withholding allowance. View more info on Tax Status/Withholding Changes. |
|
Foreign National Information (Fillable)
|
All foreign nationals must complete this form before receiving payment. |
| Hourly Intermittent Prior Pay Period Adjustment Access AEM Form |
Hourly Intermittent employees and/or departments can adjust hours worked for the pay period. |
|
I9 Form - Employment Eligibility Verification
|
The Unites States and Citizenship and Immigration Services form is used to verify identity and eligibility to work. View more info on Employment Eligibility Verification
. |
| Miscellaneous Payroll Request Form Access AEM Form |
Used to request payment of stipends and other miscellaneous payments for eligible employees. |
|
Notice of Separation
|
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 Access AEM Form |
Used to request payment of shift and overtime for eligible employees. |
| OT&SD Request Form (Combo-New- Distributed) Access AEM Form |
Used to request payment of shift and overtime for eligible employees when charges need to be distributed to another department or fund. |
|
Payroll Expenditure Transfer
|
Departments can use this form to redistribute the funding to another accounting code - department. |
| Position Action Form Access AEM Form |
Complete this form to request creation of positions, position data changes, and funding cost updates in CHRS via AEM Portal. |
| Reorganization-Supervisor Update Template |
Complete this template for supervisor updates due to reorganizations. |
| Special Consultant Timesheet 2021 Access AEM Form |
Special Consultant Employees and/or departments can submit hours worked for the pay period. |
| STD 682 Overtime (Distributed) Access AEM Form |
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 Task Profile Action Form
|
Complete this form to create, change or inactivate Student Task Profiles. If you have specific questions on this use or set up of Task Profiles, your Division Finance Coordinator or College Budget Analyst are good resources. |
| Student Timesheets Manual Entry Access AEM Form |
Student Employees and/or departments can submit hours worked for the pay period. |
|
Warrants Returned to Payroll
|
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 here
. File a claim against the California State University or any of its campuses. |
| Alcohol Use Approval Form | Download and complete this form if your event would include alcohol consumption or sales. |
| Application of Waiver of CSU Filing Fee |
Find a copy of this form here
.
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 here
.
Complete this additional form if your CSU Claim form is filed more than six months after the date of the incident. |
|
Behavior Concern Report for Acts or Threats of Violence
|
If you know of an individual that is a cause for concern regarding their behavior or an act of violence. |
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Report a Hazard or Liability
|
If you know of a hazard or liability effecting the University. |
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CSUF Waiver of Liability
|
This NEW Waiver of Liability is intended to release the University of any liability for any injuries that a participant sustains while participating in a specific activity. Additional instructions for filling out the CSUF Waiver of Liability. |
|
COVID Acknowledgment
|
|
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Student Code of Conduct Agreement
|
Student acknowledgment to follow rules and regulations of the CSU and University while participating in off campus events. |
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Request for Foreign Travel Liability Insurance
|
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. |
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University Field Trip Emergency Participant Roster
|
Completed prior to off campus activity providing student emergency contact information. Email a copy to risk@fullerton.edu |
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INF 254 – Request for Driver’s License Information
|
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. |
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STD 261 – Authorization to Use Privately Owned Vehicles on State Business
|
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.
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.
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. |
|
New!
Cal State Fullerton - Volunteer Form
|
Any individual volunteering for the University must complete this form and have approved prior to commencing service. |
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Cal State Fullerton - Minors - Volunteer Release Form
|
To be completed and signed by parent or guardian if volunteer is a minor under 18 years of age. |
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Cal State Fullerton - Volunteer Safety Briefing Form
|
General campus safety and emergency preparedness.
|
| Short Application For Employee Fee Waiver Access AEM Form
|
Application for job-related courses only. |
Student Employment
Form |
Description |
|---|---|
| Federal Work Study Position Description Template |
To be shared with Federal Work-Study within Financial Aid for approval of the position, and to provide department contact information. For more on Federal Work Study, reference this site here . |
|
Student Assistant Pre-Performance Evaluation (Student)
|
A self-evaluation for Student Assistants that can be utilized as a tool by employers. |
|
Student Assistant Performance Evaluation (Supervisor)
|
The supervisor’s version of the performance evaluation. Evaluations are recommended during the first semester of work, and annually thereafter. |
|
Student Task Profile Action Form
|
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. |
| MPP Approval for Student Assistant Appointment Form | Use this form to get approval before appointing, reappointing, or submitting pay increases for student assistants in CHRS under CSU Student Processes. |
Talent Acquisition
Form |
Description |
|---|---|
|
Temporary Service Authorization Form
|
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 Provider
|
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 Form
|
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
|
Used by Physician/Medical Provider to help determine whether an employee has a disability under the ADA. |
|
Request for Disability Accommodations Form
|
Used to request a disability accommodation. |
Benefits |
|
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Benefits Enrollment/Change Worksheet
|
Used to initiate enrollment or make changes to your health benefits. |
|
Benefits Self-Service Electronic Signature Authorization
|
Used by employee to authorize the campus Benefits Office to accept manual benefit enrollment/change requests. |
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Health Premium Deduction Authorization
|
Used by employees to authorize payroll deduction. |
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Affidavit of Parent-Child Relationship
|
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 Form
|
Used in conjunction with the Employee Fee Waiver Program when pursuing a degree. |
| Dependent Fee Waiver Program Application Access AEM Form
|
Dependent fee waiver application form. |
| Domestic Partner Certification Form Access AEM Form
|
Used by employee to determine imputed tax liability status for domestic partnership (DP) health-related benefits. |
| Employee Fee Waiver Application Access AEM Form
|
Employee fee waiver application form. |
| Short Application For Employee Fee Waiver Access AEM Form
|
Application for job-related courses only. |
Leaves |
|
| Catastrophic Leave Request Access AEM Form
|
Request for Solicitation of Donated Leave Credits and Hold Harmless Form. |
| Catastrophic Leave Donation Access AEM Form |
Donation of leave credits or sick leave by one employee to another. |
|
Request for Formal Leave of Absence
|
Used by employee to request a formal leave of absence. |
Retirement |
|
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Emeritus Request Form Faculty
|
Fillable emeritus request/nomination form for faculty members. Submit completed form to hr@fullerton.edu. |
|
Emeritus Request Form Staff
|
Fillable emeritus request/nomination form for staff, management and adminstrators. Submit completed form to hr@fullerton.edu . |
Workers' Compensation |
|
|
Departmental W.C. Posting Notice (Fullerton)
|
State of California-Industrial Relations- Division of Workers' Compensation required posting notice. |
|
Employee/Volunteer Injury/Illness Report
|
Used to report an injury or illness. |
|
Employee’s Claim for Workers’ Compensation Benefits (DWC-1)
|
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)
|
Workers' Compensation prescription drug program for injury related prescriptions. |
|
Fullerton Campus (Brea Urgent Care)
|
Used at Fullerton main campus to authorize treatment at Brea Urgent Care. |
|
Guidelines for Contact with Employees Off Work Due to an Injury or Illness
|
Return-to-Work Guidelines for supervisors when employee is off work. |
|
Sand Canyon Urgent Care
|
Used at Irvine campus to authorize treatment at Sand Canyon Urgent Care Medical Center. |
|
Saddleback Family and Urgent Care
|
Used at Irvine campus to authorize treatment at Saddleback Family and Urgent Care. |
|
Notice of Personal Chiropractor or Personal Acupuncturist
|
Used to designate personal chiropractor or acupuncturist. |
|
Physician Pre-Designation
|
Used to pre-designate personal physician. |
|
Student/Visitor Injury Form
|
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 Form
|
Form for department to appoint Chair/ Director. |
|
Faculty Action Request Form Instructions
|
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. Guide to submit a Faculty Action Request Form |
|
Faculty Additional Employment Request Form
Access AEM Form |
Form to process faculty additional work (2403 and 2359).
|
|
Faculty Early Retirement Program Request Form
Access AEM Form |
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. Guide to submit a Faculty Early Retirement Program Request Form. |
|
Full Time Lecturer Hiring Doc Checklist
- No Search |
Form Required for Full-Time Lecturer appointment packet if previously employed Full-Time and no search was conducted. |
|
Missing Hiring Documentation Waiver Form
|
Form required to be completed if there are any missing documents from the appointment packet. |
|
Pre-Retirement Reduction in Time Base Form
Access AEM Form |
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. Guide to submit a Pre-Retirement Reduction in Time Base Form. |
|
Substitute Faculty Time Sheet
Access AEM Form |
Faculty record their lectured hours as well as the hours spent in labs/or activity for each day worked. Guide to submit a Substitute Faculty Time Sheet |
|
Unit 11 Performance Evaluation Form
|
Performance evaluation form for all Unit 11 employee (Graduate Assistants, Instructional Student Assistants, Teaching Associates). |
|
Unit Unit 11 Appendix E
|
Description of Duties |
TITAN FLEX
FORM |
DESCRIPTION |
|---|---|
| 9/80 Summer Schedule Access AEM Form |
The voluntary summer 9/80 work schedule is a flexible work option that provides alternating summer Fridays off for eligible employees who opt-in. |
| Telecommute Access AEM Form |
California State University, Fullerton supports Telecommuting when the campus determines that telecommuting is operationally feasible and is in its best interest. |
