XSelf-Service will be unavailable for planned maintenance on Wednesday, March 29th beginning at 4:00 AM and is expected to be back up by 9:00 AM.

Human Resources Forms

 

 

Forms
Adjunct Faculty Health Insurance Request Form
CalSTRS Recipient Designation Form
Dental HMO Enrollment Form (2023)
Dental PPO Enrollment Form (2023)
FSA - TASC Enrollment Form (2023)
Hartford - Voluntary Life Enrollment Form
Hartford - Voluntary Life Evidence of Insurability Form
Healthcare Certification Form
Leave of Absence Request (FML - Family Medical Leave)
Leave of Absence Request (General)
Leave of Absence Request (PDL - Pregnancy Disability Leave)
Live Scan Request Form
Live Scan (Locations)
Long Term Care - UNUM - Enrollment Form (2023)
Medical Enrollment Form - Administrators' Association (2023)
Medical Enrollment Form - AFT, CSEA, Confidential Administrators and Confidential Staff (2023)
Medical Waiver form (2023)
Metlife Legal Plan Enrollment Form (2023)
Metlife Legal Plan Enrollment Form (2023)
Paid Sick Leave
Resignation/Retirement Form - Full-Time and Percent Contract Employees
Resignation/Termination Form - Adjunct and Hourly Employees
VEBA Medical Enrollment Form - A.A.
VEBA Medical Enrollment Form - General
VSP - Vision Enrollment Form (2023)
Workday User Guide for New Hires