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Last Revised: 08/09/2011

Staff HR Forms Library

Layoff/Separation Forms

COBRA Rates (Link)
  COBRA insurance continuation rates.
 
Exit Interview E-mail Template shri-9028.doc
  UCSC Staff Exit Interview E-mail Template for use by HR Partners only.  
Furlough Notice shr-1070.doc
  Template for notice of furlough.  
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  
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.  
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)  
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.  
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.
 
Unemployment Insurance Termination Report ucop-1062.pdf
  Unemployment Insurance Termination Report to be completed by the department(s) for all separating employees.  

Staff HR Procedures

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