Forms & Letters (alphabetical order)
To see the HR forms organized by category, please see the main Forms page.
Here is a list of HR forms presented in alphabetical order. Use the list below to jump to individual sections, or use Ctrl + F on your keyboard to search by name.
- ASE Childcare Reimbursement Claim Form (PDF)
- ASE Initial Appointment Notification Letter (Word)
- ASE Supplemental Notification Letter (Word)
- BELI Form (PDF) (Benefits Eligibility)
- Career Development: Action Plan (PDF)
- Career Development: Balancing Life Roles (PDF)
- Career Development: Career Counseling Request Form (PDF)
- Career Development: Competencies Assessment (PDF)
- Career Development: Decision-Making Exercise (PDF)
- Career Development: Talents Inquiry and Strengths Scan exercise (PDF)
- Clerical & Allied Services Unit (CX-CUE)
-
Compensatory Time Off (CTO)
- Clerical & Allied Services Unit (CX) (Word)
- Health Care Professional Unit (HX) (Word)
- Patient Care Technical Unit (EX) (Word)
- Police Officers Unit (PA) (Word)
- Personnel Policies for Staff Members (PPSM) (Word)
- Registered Nurses Unit (NX) (Word)
- Research Support Professional Unit (RX) (Word)
- Service Unit (SX) (Word)
- Skilled Crafts Unit (KB) (Word) and Skilled Crafts Unit (KB) - Intercollegiate Athletics or Recreational Sports (Word)
- Technical Unit (TX) (Word)
- Counseling and Discipline (Sample Letters)
- Criminal Background Check: Employee/Applicant Release and Disclosure Form (PDF)
- Criminal Background Check: New Hires (Word) (Sample Notification Letter)
- Criminal Background Check: Transfers (Word) (Sample Notification Letter)
- E-Verify (Word) (Instructions for departments)
- Employee Organization Membership Payroll Deduction Authorization form (PDF) (UPAY 669)
- Employment Eligibility Verification Form (I-9) (PDF)
- ERIT Contract and Amendment Form (PDF)
- Federal Withholding Form - Resident (PDF) (Form UC W-4/DE 4)
- Federal Withholding Form - Nonresident (PDF) (Form UC W-4NR/DE 4)
- FMLA: Caregiver Leave (Military Certification) (PDF)
- FMLA: Charting Calendar (Word)
- FMLA: Leave of Absence Request Form (PDF)
- FMLA: Leave Usage Tracking Form (Excel)
- FMLA: Medical Leave Form for Employees (PDF)
- FMLA: Medical Leave Form for Family Member (PDF)
- FMLA: Physical/Environmental/Mental Demands Form (Word)
- FMLA: Pregnancy Disability (PDF)
- FMLA: Qualifying Exigency Leave (PDF)
- FMLA: Request to Continue/Cancel Benefits Form (PDF)
- FMLA: Return to Work (PDF)
- FMLA: Sample Letters
-
Health Care Professional Unit (HX-UPTE)
- Letter #1: Indefinite Layoff, less than 5 years' Seniority (Word)
- Letter #2: Indefinite Layoff, 5 or more years' Seniority (Word)
- Letter #3: Reduction in Time or Reassignment to Partial-Year Appointment (Word)
- Letter #4: Transfer from Career to Non-Career Position (Word)
- Temporary Layoff (Word)
- Temporary Reduction in Time (Word)
- I-9: Employment Eligibility Verification Form (PDF)
- Interview Data Form: PDF and Word
- Layoff Letters: see a particular unit for specific letters (ex: Clerical and Allied Services (CUE-CX))
- Patient Care Technical Unit (EX-AFSCME)
-
Performance Management Forms
- 360 Evaluation Form (Word)
- Employee Self Assessment (Word)
- Operational and Technical Staff (Word)
- Organizational Evaluation (Word)
- Professional Staff (Word)
- Supervisors and Managers (Word)
-
Performance Management Forms for Represented Staff
- Performance Evaluation #1 (Word)
- Performance Evaluation #2 (Word)
- Performance Evaluation #2 (PDF)
- Phased Retirement Contract (U290) (PDF)
- Phased Retirement General Release of Claims (U291) (PDF)
- Physical, Environmental, and Mental Demands (PEM) Form (Word)
-
PPSM Model Layoff Letters
- Letter #1: Indefinite Layoff (Word)
- Letter #2: Indefinite Reduction in Time (Word)
- Letter #3: Temporary Layoff (Word)
- Letter #4: Temporary Reduction in Time (Word)
- Attachment A (Word)
- Pregnancy Disability Leave: Request to Continue/Cancel Benefits While on Leave (PDF)
- Pregnancy Disability Leave: Return to Work Certification (PDF)
- Pregnancy Disability Leave: Sample Letters
- Proof of Service: Mail Delivery (Word)
- Proof of Service: Personal Delivery (Word)
- Reclassification or Assignment of New Duties (Word) (Criminal Background Check - Sample Notification Letter)
- Rehire Approvals Form (PDF)
- Rehired Retiree UCRP Election Form (PDF)
- Represented Job Description Template (Word) [non-represented employee job standards can be found on the Berkeley Job Builder]
- Request a Retirement Initiation Kit (PDF)
- Request for Review (Campus Accommodation and/or Medical Separation) form (PDF) - please review the instructions before filling out this form
- Request to Continue/Cancel University Coverage (PDF)
-
Research Support Professional Unit (RX-UPTE)
- Letter #1: Indefinite Layoff, less than 5 years' Seniority (Word)
- Letter #2: Indefinite Layoff, 5 or more years' Seniority (Word)
- Letter #3: Reduction in Time or Reassignment to Partial-Year Appointment (Word)
- Letter #4: Transfer from Career to Non-Career Position (Word)
- Temporary Layoff (Word)
- Temporary Reduction in Time (Word)
- Retirement Gifts: Request Form for Staff (Word)
- Service Awards: Request Form for Staff (Word)
- Service Unit (SX- AFSCME)
- Special Leave of Absence Form (to be used for Military Leaves) (Word)
- Staff Appreciation and Recognition (STAR) Plan Nomination Form: PDF and Word
- Staff Research Association Positions addendum (Word)
- Supplement to the Retired Employee Approvals Form (PDF)
- UAW membership form (PDF)
- Unemployment Insurance Letter (Word)
- UPAY 585–State Oath of Allegiance and Patent Agreement (PDF)
- UPAY 850–Enrollment, Change, Cancellation, or Opt-out – Health & Welfare Plans (PDF)
- UPAY 919–Heath FSA/DepCare FSA Enrollment, Change or Cancellation Salary Reduction Agreement (PDF)
- Vacation Hours Transfer Form (PDF) (Catastrophic Leave)
