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Staff Human Resources
UC Santa Cruz
1156 High Street
Santa Cruz, CA 95064
Phone: 831-459-2009

Office Location: [Directions]
1201 Shaffer Road
Santa Cruz, CA 95060

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Maintained by shrweb@ucsc.edu
Last Revised: 10/29/2009

Forms Library

Staff HR Forms Listed by Form Title

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A
Alien (Resident & Non-Resident) Forms (Link)
  Links to an index page that provides links to several payroll-related forms for resident and non-resident alien employees, including associated instructions and guidelines.  
Applicant Selection Log (ASL) shr-1450.pdf
  Used to document interviewees and alternates, and reasons for non-selection of all other applicants under consideration. For more information, see Recruitment.  
Attendance, Leave Use, and Accrual - UCSC Firefighters shr-1940.pdf
  Is an official internal record used by non-exempt employees in Firefighting classifications to record hours worked, overtime/CTO accrual, and other information needed to support compensation.  
Award Nomination Form: Local Award Program shr-1350.pdf
  Used to nominate employees for awards in accordance with Awards and Recognition Program Guidelines and Procedures.  
Award Nomination Form: Staff Recognition and Development Program shr-1991.doc
  Used to nominate employees for awards in accordance with the Staff Recognition and Development Program.  
B
Background Investigation No Longer Interested (NLI) Form shr-1490.pdf
 

Used to notify the Department Of Justice that subsequent conviction information is no longer required for an employee/volunteer who previously completed a criminal history background check.

 
Background Investigation Request (BIR) shr-1480.pdf
 

One of the two forms required when initiating a criminal history background check on a potential or current employee who has accepted a critical position. Must be used in conjunction with the Live Scan Service Request)

 
Benefits Bridge Insurance Continuation - Unit 18 shr-1060.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for Unit 18 employees on Benefits Bridge.  
 
C
Catastrophic Leave Donation Flyer Sample shr-1110.doc
  Sample flyer used to call for donations of leave for an employee participating as a recepient in the catastrophic leave program. Also requires use of forms: Catastrophic Leave Recipient Application Catastrophic Leave Donor Form Catastrophic Leave Donor Roster Catastrophic Leave Service Center Worksheet. Also see Catastrophic Leave Donation Program Guidelines and Procedures.
 
Catastrophic Leave Donor Form shr-1100.pdf
  For use by an employee to donate vacation leave to another employee. Also requires use of forms: Catastrophic Leave Recipient Application Catastrophic Leave Donation Flyer Sample Catastrophic Leave Donor Roster Catastrophic Leave Service Center Worksheet. Also see Catastrophic Leave Donation Program Guidelines and Procedures.
 
Catastrophic Leave Donor Roster shr-1120.xls
  Roster for Catastrophic Leave Donations. Also requires use of forms: Catastrophic Leave Recipient Application Catastrophic Leave Donor Form Catastrophic Leave Donation Flyer Sample,   Catastrophic Leave Service Center Worksheet. Also see Catastrophic Leave Donation Program Guidelines and Procedures.
 
Catastrophic Leave Recipient Application shr-1090.pdf
  For use by a staff employee to request participation as a recipient in the UCSC Catastrophic Leave Donation Program. Also requires use of forms:  Catastrophic Leave Donor Form Catastrophic Leave Donation Flyer Sample Catastrophic Leave Donor Roster Catastrophic Leave Service Center Worksheet. Also see Catastrophic Leave Donation Program Guidelines and Procedures.
 
Catastrophic Leave Service Center Worksheet shr-1130.pdf
  Worksheet for Recipient's Service Center Administrator. Also requires use of forms: Catastrophic Leave Recipient Application Catastrophic Leave Donor Form Catastrophic Leave Donation Flyer Sample Catastrophic Leave Donor Roster. Also see Catastrophic Leave Donation Program Guidelines and Procedures.
 
Classification Review Questionnaire shr-1260.doc
  Completed by supervisor as part of the classification review package.  
COBRA Rates (Link)
  COBRA insurance continuation rates.
 
Contract Samples - MSP and PSS shr-1290.pdf
  Sample contracts for MSP and PSS employees.
 
D
Data Collection Documents for PPS (Link)
  Links to an index page that provides links to several PPS Data Collection Documents designed for use by UCSC Service Centers.  
Discrimination Complaint Form (Link)
  For employee use when reporting a compliant to the Equal Employment Opportunity/Affirmative Action office. Also see Filing a Complaint.  
E
Employee Action Request (EAR) Form shr-1250.pdf
  For use by Departments when requesting a personnel action (i.e. reclassification review, salary increase, or other action).  
Employment Opportunities Flyer Template shr-1920.doc
  Used to create Employment Opportunities Flyer. Also see additional information regarding Recruitment Advertising Resources.  
 
F
Family and Medical Leave (FML) Declaration of Relationship Sample Form shr-1200.pdf
  Declaration of Relationship for Family and In Loco Parentis Medical Leave Purposes- (Sample Form)
 
Furlough Insurance Continuation shr-1010.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for employees on furlough.  
Furlough Notice shr-1070.doc
  Template for notice of furlough.  
G
Grievance Form - Academic Student Employees (BX) shr-1815.pdf
  Greivance form for Academic Student Employees.  
Grievance Form - Clerical Employes (CX) shr-1840.pdf
  Greivance form for clerical employees.  
Grievance Form - Fire Fighters (FF) shr-1895.pdf
  Greivance form for fire fighters.  
Grievance Form - Non-Represented Academic Employees (99) shr-1800.pdf
  Grievance form for non-senate academic employees not covered by a collective bargaining agreement.  
Greivance Form - Non Represented Staff (99) shr-1800.pdf
  Complaint resolution form for staff employees not covered by a collective bargaining agreement.  
Grievance Form - Patient Care Technical Employees (EX) shr-1820.pdf
  Greivance form for Patient Care Technical Employees.  
Grievance Form - Police Officers (PA) shr-1830.pdf
  Greivance form for Police Officers.  
Grievance Form- Research Professionals (FX) shr-1800.pdf
  Complaint resolution form for Research Professionals.  
Grievance Form - Research Support Professionals (RX) shr-1850.pdf
  Greivance form for Research Support Professionals.  
Greivance Form - Residual Health Care Professionals (HX) shr-1870.pdf
  Greivance form for residual health care employees.  
Grievance Form - Technical Employees (TX) (Link)
  Greivance form for technical employees.  
 
H
I
Investigatory Leave Sample Notice shr-1080.doc
  Sample notice of an investigatory leave of absence to investigate an allegation.  
J
Job Description Addendum shr-1270.pdf
  Complete and attach to ER's and EAR's to classify positions with supervisory, managerial and confidential designations.  
Job Description Template shr-1272.pdf
  Use when creating or reclassifying any position. For instructions, please refer to the Guide for Writing Job Descriptions.  
K
L
Layoff Rescission Notice Template shr-2036.doc
 

To notice the employee of layoff rescission.

 
Layoff Revision Notice Template shr-2037.doc
 

To notice the employee of layoff revision.

 
Layoff Notice Template - Indefinite (99) shr-1520.doc
  To inform an employee not covered under a collective bargaining agreement of their layoff.  
Layoff Notice Template - Indefinite (CX) shr-1528.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (EX) shr-1544.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (HX) shr-1536.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (K7)

shr-1548.doc

  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (NX) shr-1552.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (PA) shr-1556.doc
 

To inform an employee of an indefinite layoff or reduction in time.

 
Layoff Notice Template- Indefinite (RX/TX) shr-1532.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Indefinite (SX) shr-1540.doc
  To inform an employee of an indefinite layoff or reduction in time.  
Layoff Notice Template - Probationary (99, CX, NX, and HX) shr-1524.doc
  To inform a probationary employee (99, CX, NX, and HX) of an indefinate layoff.  
Layoff Notice Template - Temporary Layoff (all staff) shr-1522.doc
 

To inform employees of their temporary layoff.

 
Layoff Notice Template - Temporary Layoff (limited) shr-1526.doc
  To inform a limited appointment employee not covered under a collective bargaining unit of their temporary layoff.  
Layoff Notice Template - Temporary Reduction in Time (all staff) shr-1523.doc
 

To inform employees of their temporary reduction in time.

 
Layoff Worksheet c17.pdf
  Layoff Worksheet  
Leave of Absence Interaction Chart shr-1154.pdf
  Information regarding interaction between Pregnancy Disability Leave, Parental Leave, and State and Federal Family & Medical Leave. Also see Leave of Absence Guidelines and Procedures.
 
Leave of Absence Medical Certification shr-1140.pdf
  Medical Certification for Leave of Absence, to be completed by employee/service center and health care provider.
 
Leave of Absence Request - Sample Transmittal Letter shr-1210.pdf
  Sample transmittal letter for a leave of absence request.
 
Leave of Absence Request Form & Instructions shr-1150.pdf
  Form to request Leave of Absence, to be filled out by employee and supervisor/service center. Includes service center instructions. Also see Leave of Absence Guidelines and Procedures.
 
Leave of Absence Return to Work Certification shr-1160.pdf
  Leave of Absence Return to Work Certification, to be completed by employee/service center and health care provider.
 
Leave of Absence Return to Work Certification - Exempt FML shr-1180.pdf
  Leave of Absence Return to Work Certification for Exempt Employee for Family and Medical Leave.
 
Leave Use and Accrual Record - Exempt shr-1230.pdf
  Is an official internal record used by exempt employees to record absences of more than a day and to track leave balances. SeeAttendance, Leave Use and Accrual Recordsfor more information.
 
Leave Use and Accrual Record - Non-Exempt shr-1240.pdf
  Is an official internal record used by non-exempt employees to record hours worked, overtime/CTO accrual, and other information needed to support compensation. See Attendance, Leave Use and Accrual Records for more information.
 
Leave With Pay Benefits Checklist (Link)
  This checklist explains how benefits are affected when on an approved leave of absence with pay (paid leave).  
Leave Without Pay Benefits Checklist (Link)
  This checklist explains how benefits are affected when on an approved leave of absence without pay.  
Leave Without Pay Insurance Continuation shr-1030.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for employees on leave without pay.  
Live Scan Service Request shr-1470.pdf
 

One of the two forms required when initiating a criminal history background check on a potential or current employee who has accepted a critical position. Must be used in conjunction with the Background Investigation Request (BIR).

 
 
M
Maximum Vacation Template- Accrual Reaching Maximum shr-1220.doc
  Used by service team to notify employee that they will reach their maximum vacation accrual. See Vacation for more information.
 
N
New Employee Information shr-1950.pdf
  This sheet contains general employment information for new employees.  
New Employee Service Team Checklist shr-1960.pdf
  A tool for Service Teams for the On-Boarding process.  
Supervisor Checklist for New Employees shr-1962.pdf
  This document is being provided to the supervisor and/or designee to assist in the orientation process of a new employee..  
New Student Employee Information shr-1990.pdf
  This document contains important information for student employees and their supervisors  
Non-Exempt Employee Time and Attendance Record (Multiple Fund Sources) shr-1988.xls
  This time record is to be used for employees who are paid on multiple fund sources as directed by your timekeeper.
 
O
On-Boarding Template - All Other Actions shri-9001.doc
  On-Boarding email template for "all other actions".  
On-Boarding Template - New Hires shri-9002.doc
  On-Boarding email template for new hires/rehires/intercampus transfers.  
On-Boarding Template - Supervisor Checklist shri-9000.doc
  On-Boarding email template for sending Supervisor Checklist.  
Overtime Compensation Election Form - Clerical Employees (CX) shr-1981.pdf
  Overtime election form for Clerical Employees. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Fire Fighters (FF) shr-1987.pdf
  Overtime election form for Fire Fighters. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Non-Represented Staff (99) shr-1980.pdf
  Overtime election form for Non-Represented Staff. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Research Support Professionals (RX) shr-1984.pdf
  Overtime election form for Research Support Professionals. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Residual Health Care Professionals (HX) shr-1982.pdf
  Overtime election form for Residual Health Care Professionals. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Service Employees (SX) shr-1985.pdf
  Overtime election form for Service Employees. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Skilled Crafts Employees (K7) shr-1983.pdf
  Overtime election form for Skilled Crafts Employees. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
Overtime Compensation Election Form - Technical Employees (TX) shr-1986.pdf
  Overtime election form for Technical Employees. Please view Overtime Compensation for Non-Exempt Employees for additional information.  
P
Paytran Forms (Link)
  Links to an index page that provides links to several Paytran Forms.  
Performance Appraisal and Development Forms  
  There are several Performance Appraisal and Development Form options available at the link above. For more information on how to use and access these forms, see Performance Appraisal Instructions for Supervisors.  
Personnel File Access Request Form shr-1360.pdf
  Used by current and former staff employees to request access to their personnel file from Staff Human Resources. Requests for files from service centers must be made directly to the service center. Academic employees should contact AHR.  
Post Authorization Notification (PAN) Routing Forms (Link)
  Links to an index page that provides links to several Post Authorization Notification (PAN) Routing Forms, as well as their associated guidelines.  
Proof of Service Form shr-1370.pdf
  Fill out and attach with original and copies when proof of service or statement of delivery or mailing is required. Copies to appropriate files. (e.g., Notice of Intent)  
Q
R
Recruitment Ad Template shr-1970.doc
  Contains standard ad copy used to create UCSC employment ads. Ads placed by Employment will utilize this format unless otherwise requested. For more information, see Recruitment Advertising Resources.  
Reduced Fee Application Form shr-1380.pdf
  Application to receive reduced training fees for participating training programs. For career staff employees who have worked 6 months or more and completed probation, faculty and non-senate academic appointeeswho have worked at least 50% time for 6 months or more, and retirees. [Guidelines]  
Regular Rate & Premium Overtime Pay Calculations shr-1700.xls
  Contains calculations for the "regular" rate of pay required when paying out overtime to employees who have stipends in addition to their normal appointments and shift differentials. SeeOvertime Recording and Compensationfor full instructions.  
RMS Worksheet: Job Offer - Open/Campus-Only Recruitments shr-2002.doc
  Used by the hiring unit to document the terms and conditions of the offer to the selected candidate and the reasons why other interviewed candidates were not selected. For more information see Recruitment.  
RMS Worksheet: Non-Recruitment shr-2003.doc
  Used by the hiring unit to to fill a temporary staff vacancy through non-recruitment. For more information, see Non-Recruitment.  
RMS Worksheet: Open/Campus-Only - all types except Straight Replacement shr-2000.doc
  Used by the hiring unit to initiate a request to fill a staff vacancy through Open or Campus-Only Recruitment. If you are requesting a straight replacement previously recruited for in RMS use RMS Worksheet: Open/Campus-Only - Straight Replacement. For more information, see Recruitment.  
RMS Worksheet: Open/Campus-Only - Straight Replacement shr-2001.doc
  Used by the hiring unit to initiate a request to fill a staff vacancy through Open or Campus-Only Recruitment that has previously been recruited in RMS, and no changes were made to the job description. Use RMS Worksheet: Open/Campus-Only - all types except Straight Replacementfor all other recruitment requests. For more information, see Recruitment.  
RMS Worksheet: Supplemental Job Offers - Non-Recruitment or Waiver of Recruitment shr-2005.doc
  Used by the hiring unit when requesting more than one hire from a Non-Recruitment or Waiver of Recruitment. This form should be used in conjunction with the RMS Worksheet: Non-Recruitment or the RMS Worksheet: Waiver of Recruitment.  
RMS Worksheet: Waiver of Recruitment shr-2004.doc
  Used by the hiring unit to fill a vacancy through a waver of recruitment. For more information, see Waiver of Recruitment.  
 
S
Separation - Job Abandonment Notice of Failure to Return from Leave Template shri-9016.doc
  This template is to be used by supervisors and managers to draft Notice of Failure to Return from Leave letter  
Separation - Job Abandonment Notice of Final Decision Template shri-9014.doc
  This template is to be used by supervisors and managers to draft Final Job Abandonment Notice Letter.  
Separation - Job Abandonment Notice of Intent to Separate Template shri-9013.doc
  This template is to be used by supervisors and managers to draft an initial Job Abandonment Notice Letter.  
Separation - Job Abandonment Notice of Unexcused Absenteeism Template shri-9015.doc
  This template is to be used by supervisors and managers to draft Notice of Unexcused Absenteeism letter  
Separation - Job Abandonment Template shri-9010.doc
  This template is to be used as a cover letter when mailing separation documents to employees that have separated due to job abandonment.  
Separation: Notice of Intent to Medically Separate Template (Non-Represented Employee) shri-9020.doc
  This template is to be used by the Service Teams to draft the Notice of Intent to Medically Separate letter for a Non-Represented employee.  
Separation: Notice of Intent to Medically Separate Template (Represented Employee) shri-9021.doc
  This template is to be used by the Service Teams to draft the Notice of Intent to Medically Separate letter for a Represented employee.  
Separation: Notice of Intent to Medically Separate Template (Non-Represented Employee, UCRP Disability) shri-9022.doc
  This template is to be used by the Service Teams to draft the Notice of Intent to Medically Separate letter for a Non-Represented employee approved for UCRP Disability Income.  
Separation: Notice of Intent to Medically Separate Template (Represented Employee, UCRP Disability) shri-9023.doc
  This template is to be used by the Service Teams to draft the Notice of Intent to Medically Separate letter for a Represented employee approved for UCRP Disability Income.  
Separation: Notice of Medical Separation Template (Non-Represented Employee) shri-9024.doc
  This template is to be used by the Service Teams to draft the Notice of Medical Separation letter for a Non-Represented employee.  
Separation: Notice of Medical Separation Template (Represented Employee) shri-9025.doc
  This template is to be used by the Service Teams to draft the Notice of Medical Separation letter for a Represented employee.  
Separation: Notice of Medical Separation Template (Non-Represented Employee, UCRP Disability) shri-9026.doc
  This template is to be used by the Service Teams to draft the Notice of Medical Separation letter for a Non-Represented employee approved for UCRP Disability Income.  
Separation: Notice of Medical Separation Template (Represented Employee, UCRP Disability) shri-9027.doc
  This template is to be used by the Service Teams to draft the Notice of Medical Separation letter for a Represented employee approved for UCRP Disability Income.  
Separation - Resignation or Indefinite Layoff Template shri-9011.doc
  This template is to be used as a cover letter when mailing separation documents to employees that have separated due to Resignation or Indefinite Layoff.  
Separation - Retirement Template shri-9012.doc
  This template is to be used as a cover letter when mailing separation documents to employees that have separated due to Retirement.  
Service Credit Verification Request shr-1650.pdf
  Used by UCSC employees to request verification of previous employment with another UC campus or California state agency.  
START 2008-2010 Contract shr-2022.doc
  The Staff and Academic Reduction in Time (START) Program Contract is to be used by eligible UCSC employees requesting participation in the 2008-2010 START Program. For more information, see Staff Academic Reduction in Time (START) Program.  
START 2008-2010 Contract Amendment shr-2021.doc
  The Staff and Academic Reduction in Time (START) Program Contract Amendment is to be used by UCSC employees participating in the 2008-2010 START Program, in order to request a change to the original START Program Contract. For more information, see Staff Academic Reduction in Time (START) Program.  
Student Employee Merit Recommendation Sample Form shr-1670.pdf
  To be used if service team/department has adopted merit/performance related salary adjustments for student employees. See Student Compensation Program and Student Employment Policies and Procedures for more information.  
Student Employee Performance Rating Sample Form shr-1680.pdf
  To be used if service team/department has adopted merit/performance related salary adjustments for student employees. See Student Compensation Program and Student Employment Policies and Procedures for more information.  
Student Employee Performance Rating Sample Form - Narrative shr-1690.pdf
  To be used if service team/department has adopted merit/performance related salary adjustments for student employees. See Student Compensation Program and Student Employment Policies and Procedures for more information.  
Student Time Record shr-1989.xls
  Student Time Record for both work-study and non work-study student employees.  
Supplement to Military Pay Worksheet (Link)
  Required when employees are called to active military duty while employed by the University; form helps determine if employee is eligible for military pay according to University policy and implementing guidelines. For more information, see Supplement to Military Pay Policies (UCOP).  
Suspension - Sample Notice shr-1410.doc
  Written notice of corrective action. See Staff HR Procedures Corrective Action -- PSS and PPSM 62. Include a Proof of Service Form.  
Suspension - Sample Notice of Intent shr-1400.doc
 

Written notice of intent to take corrective action is required, except for a written warning or a suspension pursuant to PPSM 62. See Staff HR Procedures - Corrective Action -- PSS and PPSM 62. Include a Proof of Service Form.

 
 
T
Telecommuting Sample Agreement shr-1280.pdf
  Sample telecommuting agreement for UCSC employees.
 
Temporary Vacation Leave Conversion Program (TVLCP) Employee Request Form shr-1930.pdf
  Request form allowing employees to convert accrued vacation leave into cash contributions for donations to qualified tax-exempt organizations providing Hurricane Katrina disaster disaster relief. Also see TVLCP Procedures and Temporary Vacation Leave Conversion Program (TVLCP) Employee Request - Completed Sample Form.  
Termination - Sample Notice shr-1430.doc
  See Staff HR Procedures - Other separations and PPSM 64 or PPSM 65 or appropriate collective bargaining agreement.  
Termination - Sample Notice of Intent shr-1420.doc
  Written notice of intent to terminate is required prior to termination. See Staff HR Procedures - Other separations and PPSM 64 or PPSM 65 or appropriate collective bargaining agreement.  
Trial Employment Sample Letter - Non-Represented shr-1300.doc
  Template letter used when placing a preferential rehire candidate into a Professional and Support Staff (PSS) career position.
 
Trial Employment Sample Letter - Represented shr-1310.doc
  Template letter used when placing a preferential rehire candidate into a career position covered by a collective bargaining agreement.
 
U
UC Benefits Forms (Link)
  University of California At Your Service provides benefits forms & publications.  
Unemployment Insurance Termination Report ucop-1062.pdf
  Unemployment Insurance Termination Report to be completed by the department(s) for all separating employees.  
University of California Retirement Plan (UCRP) Waiver and Factsheet (Link)
  UCRP Waiver and Release Form, including guidelines for reemployment after retirement.  
V
Volunteer Agreement Letter & Worker’s Compensation Election Form shr-1660.pdf
  Required for employees volunteering services within their division/department — services may not be the same as those for which the employee is paid by the University. For more information, see Volunteers.    
W
Warning Letter Sample shr-1390.doc
  Normally, at least one written warning precedes any other more serious corrective action except when corrective action is the result of performance or conduct which an employee knows or reasonably should have known was unsatisfactory.  
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