Human Resources Forms

Employment

Temporary Worker Extension Request Faculty Deferred Compensation Form
Additional Assignment Authorization Form Performance Appraisal Forms and Guidelines
Conflict of Interest Disclosure Form Staff Telecommuting Agreement
Employment of Relatives Disclosure Form Contingent Worker Authorization Request Form

Compensation

Job Description Template

Job Aid to Complete Job Description

Benefits

General:

Kaiser:

Anthem Blue Cross:

Dental/Vision:
2020 Childcare Subsidy Enrollment Form 2021 Kaiser Summary of Benefits Chiropractic Home Delivery Pharmacy Booklet Delta Dental Claim Form
CIGNA Life and Accident Insurance Application 2021 Kaiser Summary of Benefits NorCal Plan Prescription Claim Form Evidence of Coverage and Disclosure Form
Lactation Accommodation Request Form 2021 Kaiser Summary of Benefits SoCal Plan Home Delivery Pharmacy Order Form VSP Member Reimbursement Form 
    Member Claim Form  

Retirement:

USFFA:
Financial Advisor Reimbursement Form USFFA Second Mortgage Program Description

Fidelity Incoming Rollover Form

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

Tuition:

SF HCSO and SF Sick Leave:
Tuition Remission Form HCSO Employee Voluntary Waiver Form
Tuition Remission Plan Designated Person Sick Form for Paid Sick Leave
FACHEX and Tuition Exchange Form

Flexible Spending Accounts:
FACHEX Program - Participating Institutions BRI Dependent Care FSA Reimbursement Claim Form
FACHEX and Tuition Exchange Programs FAQ BRI FSA Direct Deposit Form
  2022 BRI FSA Guide
  2022 BRI Plan Highlights

Commuter:

  
Pre-Tax Commuter Plan and Subsidy Enrollment Form  

Wellness:

Payroll:
Gym Membership Reimbursement Form* All Payroll Forms
Wellness Event Reimbursement Form  
(*for employees not on Hilltop campus)

Workers' Compensation:
  Workers' Compensation Benefits (English version)
  Compensación por Accidentes de Trabajo (versión en español)
  Medical Provider Network (MPN) Notice

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