HR Forms
The forms in this section are generally in Microsoft Word (.doc) or Portable Document Format (.pdf). PDF files can be viewed by using the Adobe Acrobat Reader, which is available free from the Adobe site. Adobe Reader 7.0 or higher is recommended.
Payroll forms, including Direct Deposit, are available on the Payroll website.
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Click on a subject area below to expand the list of forms.
Benefits
Many benefits forms and publications can be found online or ordered from the KP Supply Warehouse.
Department Benefits Counselors (DBCs)
COBRA
Eligibility
- BELI Form (PDF)
Employment Events: Rehiring Retirees
- Rehire Approvals Form (PDF)
- UC Berkeley Supplement to the Retired Empoyee Approvals Form (PDF)
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Rehired Retiree UCRP Election Form (password-protected)
Contact HR Benefits if you need the password: benefits@berkeley.edu or 642-7053.
Health & Welfare Plans
Leaves
Rehiring UC Retirees
- Rehire Approvals Form (PDF) (UBEN 1038)
- UCRP Retired Employment Election Form (PDF) (UBEN 1039)
- UC Berkeley Supplement to the Retired Employee Approvals Form (PDF)
Retirement & Retirement Savings Plans
Compensation & Classification
Please click on the following links to view, download and print the forms:
Job Standards / Job Description Templates
- Represented Job Description Template (Word) [non-represented employee job standards can be found on the Berkeley Job Builder]
- Staff Research Associate Positions addendum (Word)
Diversity & Inclusion
Please click on the following links to view, download and print the forms:
Demographic Data
- HCM Instructions (PDF)
- Transmittal Form (PDF)
Employee Relations
Please click on the following links to view, download and print the forms:
Catastrophic Leave Sharing Program
- Vacation Hours Transfer Form (Word)
Compensatory Time Off (CTO)
Counseling & Discipline
Criminal Background Check
- Employee/Applicant Release and Disclosure Form (PDF)
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Sample Notification Letters:
- New Hires (Word)
- Reclassification or Assignment of New Duties (Word)
- Transfers (Word)
Family & Medical Leave Packet
- At Your Service
-
Certifications
- Medical Leave Form for Employees (PDF)
- Medical Leave Form for Family Member (PDF)
- Pregnancy Disability (PDF)
- Return to Work (PDF)
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Military Certifications
- Qualifying Exigency Leave (PDF)
- Caregiver Leave (PDF)
- Forms, Checklists and Facts
- Other
Layoffs
Medical Separation
- Request for Review (Campus Accommodation and/or Medical Separation) form (PDF) - please review the instructions before filling out this form.
Miscellaneous Template Letters
- Letter of Investigatory Leave (Word)
- Letter of (Lateral) Reassignment or Transfer (with Location or Supervisor Change) (Word)
- Letter of Downward Reclassification (Word)
- Letter of Upward Reclassification (Word)
- Letter to Release Employee from Probationary Period (Word)
- Letter to Extend Probationary Period (Word)
- Letter to Release Employee from Limited Appointment (Word)
Military Leave
PPSM Model Layoff Letters
Pregnancy Disability Leave (PDL)
- Medical Certification for Employee's Pregnancy Disability (PDF)
- Return to Work Certification (PDF)
- Request to Continue/Cancel Benefits While on Leave (PDF)
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Sample Letters:
- Employee FML Eligible (PDF) - For combined PDL and Parental Leave
- Employee Not FML Eligible (PDF) - For requests for PDL only
- Employee FML Eligible but Leave Entitlement Exhausted (PDF) - For Requests for PDL only
- Employee FML Eligible (PDF) - For Requests Limited to PDL
- PDL Confirmation Letter (PDF) - Employee Not FML Eligible or Employee FML Eligible but Leave Entitlement Exhausted
- Letter for Change in End Date of PDL (PDF) - For Approved Combined PDL and Parental Leave
Reduced Fee Enrollment Program
Telecommuting
Employment
Please click on the following links to view, download and print the forms:
Interview Data Form and Physical, Environmental, and Mental Demands (PEM) form
- Interview Data Form: PDF and Word
- Physical, Environmental, and Mental Demands (PEM) Form (Word)
Labor Relations
Please click on the following links to view, download and print the forms:
Compensatory Time Off (CTO)
Contracts (forms and sample letters)
Payroll Deduction Authorization (Agency Fees)
Proof of Service
- Personal Delivery (Word)
- Mail Delivery (Word)
Learning & Development
Please click on the following links to view, download and print the forms:
Career Development
Performance Management
Please click on the following links to view, download and print the forms:
Performance Evaluation and Planning Forms
- Supervisors and Managers (Word)
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Professional Staff (Word)
NOTE: To aid in performance assessment of the competencies in Part II-B of the above Performance Management forms, we have added behavioral anchors for three out of the ten core competencies listed. These behavioral anchors are available for download as a PDF here: Behavioral Anchors Matrix (PDF). Anchors for the remaining seven core competencies will be added by September 2012.
- Operational and Technical Staff (Word)
- 360 Evaluation Form (Word)
- Organizational Evaluation (Word)
- Employee Self Assessment (Word)
Performance Evaluation Forms for Represented Staff
- Performance Evaluation #1 (Word)
- Performance Evaluation #2 (Word)
- Performance Evaluation #2 (PDF)
Records Management
Please click on the following links to view, download and print the forms:
Hiring Forms
- Hire/Rehire Required Forms Checklist
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Demographic Data:
- HCM Instructions (PDF)
- Transmittal Form (PDF)
- E-Verify (Instructions for departments) (Word) - Includes letter templates for existing and new employees
- I-9:
- UPAY 585–State Oath of Allegiance and Patent Agreement (PDF)
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W-4:
- Federal Withholding Form - Resident (Form UC W-4/DE 4) (PDF) - This form can be filled in electronically. Read notes on form about privacy.
- Federal Withholding Form - Nonresident (Form UC W-4NR/DE 4) (PDF) - This form can be filled in electronically. Read notes on form about privacy.
- Instructions for Entering W-4 Tax Allowances via At Your Service Online (PDF)
Retirement Gifts
- Request Form for Staff (Word)
Service Awards
- Request Form for Staff (Word)
