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Staff HR Forms Library

Benefits Forms

Benefits Bridge Insurance Continuation - Unit 18 shr-1060.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for Unit 18 employees on Benefits Bridge.  
COBRA Rates (Link)
  COBRA insurance continuation rates.
 
Furlough or Temporary Layoff Insurance Continuation shr-1010.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for employees on furlough or temporary layoff.  
Leave Without Pay Insurance Continuation shr-1030.pdf
  UCSC Insurance Continuation Election Form, instructions, and rates for employees on leave without pay.  
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.