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Forms and Notices


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Note: To view and print the forms in PDF Files, Adobe Acrobat Reader is required. It can be downloaded free from Adobe Website.


  • Absence Requests/Notification -   Submit form to your supervisor PRIOR to planned leave
  • Absence Reports - to be completed after return from leave
  • Catastrophic Leave Request form
  • CFRA Notice   (California Family Rights Act)
  • FMLA Information (Family Medical Leave Act - in general, to be eligible an employee must have been employed for at least 12 months and have worked at least 1,250 hours in the 12 months preceding the leave (excluding all paid and unpaid time off, including sick leave, vacation, and holidays.  Eligible employees are entitled to 12 work weeks of family leave in any 12-month period, which shall be counted backward from the date family leave is taken.  Certifications are required to utilize FMLA/CFRA leave.  Contact Human Resources at x2468 for details.


  • Amenities Donation - Benefits-eligible employees would enroll by electing through the EBenefits system or by filling out the Amenities Form, printing and submitting it to HR.
  • Deferred Net Pay form for full-time faculty(automatically save part of your 10 pay warrants for disbursement on July 1 and August 1); and for Classified 10 or 11 month employees, disbursed on your off-month(s) payroll date(s).
  • Direct Deposit - Electronic Deposit Form (EFT) - electronic fund transfer of payroll funds - mail, deliver, fax to Payroll; must include required bank documents
  • Foundation Donation - Call the Foundation office at ext 2522 for information on a donation form - OR -   Benefits-eligible employee would elect this contribution within the EBenefits system;  please log in to elect and designate your contribution. 
  • Payroll Request for Payment Form - used for stipend-type payments - coaching or other special certificated assignments, etc.- CONTRACT required.  Form is available in the payroll or dean's office.
  • Taxes: 
W-4 (Federal Withholding)
Annual EITC notice (earned income tax credit)
DE 4 (California Withholding Certificate) - needed only if you wish your state exemptions be different than your federal W-4 exemptions
W-2 Request for Duplicate (W-2 generally available thru online access to most recent and prior year W-2s available through the BESTNET link to the left)


403( b)(7) Tax Shelter Annuities (TSA) for eligible employees

  • 457(b) Deferred Compensation Plan - (regular employees and adjunct faculty) - Elite Choice 457(b) Deferred Compensation Plan.  Contact us for information.


CalPERS   Then click on Forms and Publications Center to the right of the screen (address/purchase/redeposit service credit, beneficiary form, and more)


Many documents and forms are located within the new EBenefits online enrollment system.  Benefits-eligible employees may log in for access.

  • HIPAA (Health Insurance Portability)


Workers Compensation (Industrial Injury/Illness)

  • Incident/accident report and DWC1 Claim form - available in Human Resources, Bldg 10
  • Pre-designated Physician form (available for benefits-eligible employees only)
  • MPN Covered Employee Notification of Rights Materials notice (5-page Medical Provider Network information)


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Note: To view and print the forms in PDF Files, Adobe Acrobat Reader is required. It can be downloaded free from Adobe Website.


Last Updated 12/18/18