Human Resources, University of California, Berkeley

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Human Resources Management System

Hire/Rehire Forms

All forms should be submitted to the Human Resources Records & Data Management unit unless otherwise specified.
The Records & Data Management mailing address is 2150 Shattuck Ave, Suite 750, Berkeley, CA 94704-3540.
Fax: (510) 642-1882

Form	Reference	Submission Instructions
State Oath of Allegiance	UPAY585	U.S. citizens only. (Rehire - Not required if signed within the past 12 months.)	Present full document. Employee must sign on or before first day of service. Signature must be witnessed and countersigned.
Patent Policy Acknowledgement	UPAY585	All employees. (Rehire - Required.)
Employment Eligibility Verification (Form I-9)	Federal I-9	Employee must complete and sign Section 1 on or before date employment begins. Employee must show evidence of identity and employment eligibility within 3 business days of date employment begins. Department completes Section 2 when employee presents eligibility documents. Non-Resident aliens must submit work authorization documents. (Rehire - Not required if signed within the past 36 months, by Federal Law.)
Benefits Eligibility Level Indicator (BELI) or Status Qualifier Code (SQC)	UPAY 726	Submit each time a change occurs to an employee's eligibility for health and welfare benefits. Different individuals should sign "Completed by" and "Department Approval" sections. (Rehire - New form is required, unless employee's BELI code remains 5-Ineligible. Always update the BELI Effective Date in HRMS.)
Demographic Data Transmittal	U5605	Completion of this document by the employee is voluntary - there is no penalty for not completing. Information in this document is confidential. Destroy after entry into HRMS. DO NOT keep copies. DO NOT send copies to HR. Note: Demographic information is collected by UC for federal contract requirements. All questions regarding this document should be directed to the Staff Equal Employment Opportunity Compliance (SEEOC) office.
Payroll Earnings Distribution Authorization (Direct Deposit)	UPAY 544A-1	Not required if employee enters information through HRMS Self-Service. Form requires an attached voided check or savings deposit slip. This form should be kept in the Departmental Personnel file. (Rehire - New form is required if information has changed. Always insert a new Direct Deposit row in HRMS, even if information has not changed.)
Federal/State Withholding Allowance Certificate Resident W-4 Non-resident W-4	UC W-4/DE 4UC W-4NR/DE 4	Not required if employee enters information through UCOP's At Your Service web site: http://atyourservice.ucop.edu/ Submit form whenever withholding information is entered or updated by department. (Rehire - New form is required if information has changed. Always insert a new Employee Tax Data row in HRMS, even if information has not changed.)
Statement - Employment not Covered by Social Security	UCRS 419	All employees in a position that is not covered by Social Security on or after January 1, 2005 (e.g. Safety Personnel, DC Plan Safe Harbor employees, certain UC students and non resident aliens etc. - see form for complete list). (Rehire - Required)
Certificate of Foreign Status for Federal Tax Withholding	GLACIER	For resident aliens and non-resident aliens: Complete GLACIER process and print, sign and submit forms along with visa/work authorization documents to Marcia Johnson in the payroll office.
Health Insurance and Flexible Spending Account forms	UPAY850, UPAY717, UPAY919	Hire/Rehire - submit directly to HR Benefits office. Any changes during a Period of Initial Eligibility (PIE) and/or any exceptions, submit directly to HR Benefits office. Open enrollment changes are done online.

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