Human Resources Forms

Employment

Temporary Worker Extension Request  
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:
2020 Childcare Subsidy Enrollment Form Home Delivery Pharmacy Booklet Delta Dental Claim Form
CIGNA Life and Accident Insurance Application Prescription Claim Form Delta Dental Benefit Highlights
CIGNA Beneficiary Form Home Delivery Pharmacy Order 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
Return to Work Certification form    

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
  Designated Person Sick Form for Paid Sick Leave
Tuition Remission Plan

Flexible Spending Accounts:
FACHEX and Tuition Exchange Form BASIC Pacific FSA Reimbursement Claim Form
FACHEX Program - Participating Institutions BASIC Pacific FSA Direct Deposit Form
FACHEX and Tuition Exchange Programs FAQ 2019 BASIC Pacific FSA Employee Summary
  2019 BASIC Pacific FSA Welcome Packet
  2020 BASIC Pacific FSA Employee Summary
  2020 BASIC Pacific FSA Welcome Packet

Commuter:

  
Pre-Tax Commuter Plan and Subsidy Enrollment Form  

Wellness:

Payroll:
GoUSF Event RSVP form All Payroll Forms
Gym Membership Reimbursement Form*  
Wellness Event Reimbursement Form

Workers' Compensation:
Ergonomics Assessment Form Workers' Compensation Benefits (English version)
(*for employees not on Hilltop campus) Compensación por Accidentes de Trabajo (versión en español)
  Medical Provider Network (MPN) Notice

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