Human Resources Forms

Employment

Additional Assignment Authorization Form Performance Appraisal Forms and Guidelines
Conflict of Interest Disclosure Form Staff Telecommuting Agreement
Employment of Relatives Disclosure Form Special Affiliate Request Form

Benefits

General:

Anthem Blue Cross:

Dental/Vision:
Childcare Subsidy Form Home Delivery Pharmacy Booklet Delta Dental Claim Form
CIGNA Life and Accident Insurance Application Home Delivery Pharmacy Order Form Delta Dental Benefit Highlights
CIGNA Beneficiary Form Prescription Claim Form Delta Dental Summary Plan
Lactation Accommodation Request Form Member Claim Form VSP Benefit Highlights
Leave of Absence (LOA) Request Form   VSP Summary of Benefits

Retirement:

USFFA:

Financial Advisor Reimbursement Form

 Rent Reimbursement Request Form

Fidelity Incoming Rollover Form

 Relocation Reimbursement Request Form
TIAA 403(b) Incoming Rollover Form USFFA Second Mortgage Program Description
401(a) Vesting Waiver Form USFFA Second Mortgage Program Application
Emeriti Qualified Medical Expense Form Relocation Assistance Vendor

Tuition:

SF HCSO and SF Sick Leave:
Tuition Remission Form HCSO Employee Voluntary Waiver Form
Tuition Remission Plan HCSO HRA Claim Form
FACHEX and Tuition Exchange Form HCSO HRA Direct Deposit Form
FACHEX Program - Participating Institutions HCSO HRA Welcome Packet (new enrollees)
FACHEX and Tuition Exchange Programs FAQ HCSO HRA Complete Employee Packet (continuing enrollees)

Flexible Spending Accounts:

 HCSO HRA Qualified Expenses - Dental/Vision/LTC Excepted Benefit
BASIC Pacific FSA Reimbursement Claim Form Designated Person Form for SF Paid Sick Leave
BASIC Pacific FSA Direct Deposit Form

Commuter:
BASIC Pacific FSA Employee Packet Pre-Tax Commuter Plan and Subsidy Enrollment Form
BASIC Pacific FSA Welcome Packet  

Wellness:

Payroll:
GoUSF Event RSVP form Out-of-State Income Tax Withholding Form
Gym Membership Reimbursement Form* Authorized Payroll Check Courier Form
Wellness Event Reimbursement Form Special Check Request
Ergonomics Assessment Form OPE Vacation Request Form
(*for employees not on Hilltop campus) All Payroll Forms

Workers' Compensation:

  
Workers' Compensation Benefits  
Medical Provider Network (MPN) Notice  

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