Human ResourcesForms & Calendars

A - C


ACE Classified Performance Evaluation Form

ACE Educational Reimbursement Form

ACE PGA Application and Guidelines

ACE Recess Form (2019)

ACE Travel and Conference Fund Application

ADA Request for Accommodation

Additional Pay Form (District FTF)

Administrative Achievement Award Application

Administrative Grievance Form

Administrative Performance Appraisal (Evaluation) Form

Administrative Reclassification Appeal Form

Authorization to Eliminate Position

Admin Early Notice Incentive Program Application

Anthem Blue Cross Member Claim Form - Medical


2018-2019 Academic Calendar

2019-2020 Academic Calendar

2018-2019 & 2019-2020 Holiday Calendars

2018 Pay Day Calendar

2019 Pay Day Calendar

CalPERS Affidavit of Marriage and Domestic Partnership - Form PERS HBSD-1965

CalPERS Affidavit of Parent-Child Relationship - Form HBD-40

CalPERS Beneficiary Designation

CalPERS Certification of Medicare Status

CalPERS Declaration of Health Coverage for Employees - Form HBD-12a

CalPERS Direct Payment Authorization

CalPERS Disabled Dependent Medical Certification - Form HBD-34

CalPERS Disabled Dependent Questionnaire - Form HBD-98

CalPERS Health Plan Enrollment for Employees - Form HBD-12 (Active Employees)

CalPERS Health Benefits Enrollment Form (Retirees)

Change of Address Form (Retiree)

Classified Performance Evaluation Instructions

Classified Performance Evaluation Form (EXCEPT  ACE - see ACE Classified Performance Evaluation Form)

Classified Hourly Performance Evaluation Form

C.O.B.R.A Request Form (Active Employees)

C.O.B.R.A. Request Form (Retirees)

Conexis FSA Dependent Care Account Claim Form

Conexis FSA Enrollment Form

Conexis FSA Health Care Account Claim Form

Conexis FSA Medical Determination Form

Confidential Educational Reimbursement Form

Contract Change Form

CSEA Apprenticeship Application Form

CSEA Apprenticeship Evaluation Form

CSEA Educational Reimbursement Form

CSEA PGA Application

CSEA Recess Form (2019)

CSEA Travel and Conference Form

CVS Caremark Rx - Mail Order Form

CVS Caremark Rx - Retail Claim Form


D - L


Delta Dental Claim Form

Donation Sick Leave Pledge Form


Educational Achievement Request Form (Administrators)

Electronic Fund Transfer (EFT) Authorization Form

Equivalency Form

Faculty Leave Exception Form

FMLA and PDL Application

Hartford Beneficiary Designation Form

Hartford Buy-Up Long-Term Disability Application

Hartford Insurance Death Claim form

Hartford Life Portability Application Form

Hartford Long Term Disability Application Form (LTD)

Hartford Notice of Conversion Form

Independent Contractor Agreement (ICA)


M - R


Medical Certification Initiating Leave

Medical Certification Release and Return to Work

PAA Application

PDL Application (P1) - Due Tuesday, October 15, 2019 (by 5 pm)

PDL Change Request (P2)

PDL Leave Report (P3) - Due after your last quarter of PDL Leave, 30 calendar days after your return to campus.

Reassigned/Release Time Authorization Form


S - T


Staff Development Leave Application

Staff Development Leave Information

State of California Employer's Report Form(Form 5020)

Student Evaluation - Part A Envelopes

Student Evaluation - Part B Envelopes

Student Evaluation - Confidential Page

Substitute Request for Pay

Supervisor's Claim and Safety Report

Supplemental Life and AD&D Application-Personal Health Form

Teamsters Educational Assistance Form

Teamsters PGA Application and Guidelines

Teamsters Recess Form (2019)

Training/Retraining Application (Appendix I) - Administrators

Training/Retraining Application (Appendix R) - Faculty - Due Monday, April 15, 2019 (by 5 pm)

Training/Retraining Reimbursement Request Form - Administrators

Training/Retraining Reimbursement Request Form - Faculty

Transfer Sick Leave Form


U - Z


Universal Enrollment Form (for changes/additions/deletions of ALL dependents)

Universal Enrollment Form (for PTF w/o REP and TEA for 6 months plus 1 day employment status)

Unlawful Discrimination Complaint Form (Updated Nov 2018)

Workers' Comp Report of Injury Form

Working Out-of-Classification (WOC) Form