Forms

Academic Employees, Evaluations

Benefits

Academic Employees, Benefits

Equal Opportunity and Compliance

  • This confidentiality form is to be used by applicants or employees who are requesting an accommodation based on a disability. Applicants and employees requesting services will be subject to qualification standards as defined by federal and state laws relating to disability.
  • Employee/applicant shall contact the treating health care provider to complete this form. Employee/ applicant should return the completed form to ADA coordinator at Cal Poly Humboldt Human Resources.
  • This request form should be utilized for COVID related disability accommodations. Employee/applicant shall contact the treating health care provider to complete this form. Employee/ applicant should return the completed form to ADA coordinator at Humboldt-HR.
  • Acknowledgement of Mandated Reporter Status and Legal Duty to Report Child Abuse and Neglect (EO 1083)
  • California law requires certain people, known as “Mandated Reporters,” to report known or suspected child abuse or neglect. You have been identified as a certain type of Mandated Reporter: a Limited Reporter under Penal Code § 11165.7(a)(41). As a Mandated Reporter, you are required by the law to sign this statement acknowledging your legal reporting obligations.
  • Child Abuse Reporting Form
  • To Be Completed by Mandated Child Abuse Reporters Pursuant to Penal Code Section 11166
  • This complaint form is for use by individuals who are eligible to file a complaint of Discrimination, Harassment, Retaliation, Sexual Misconduct, Dating or Domestic Violence or Stalking under Executive Order 1096.
  • Student Complaint Form
  • This form is used to report certain payments received by state and local government agencies. It includes: • a payment for an official’s travel expenses for the purpose of facilitating the public’s business in lieu of a payment using agency funds; and • a payment that would otherwise be considered a gift or income to the benefiting official, but is instead accepted on behalf of the agency.
  • This complaint form is to be used to file a Protected Disclosure of Improper Governmental Activities and/or Significant Threats to Health or Safety under Executive Order 929.
  • The California Whistleblower Protection Act authorizes the California State Auditor to receive complaints from state employees and members of the public who wish to report an improper governmental activity. Note: Complaints are not accepted via email.

Onboarding

  • Apply for an original Social Security card, apply for a replacement Social Security card, change or correct information on your Social Security number record
  • The Reciprocal Self-Certification form allows you to provide essential information to your employer and will be used by your employer to enroll you into CalPERS membership.
  • The Account Request process is used to add, modify, or delete a person's (user or developer) access to PeopleSoft Human Resources, PeopleSoft Campus Solutions, Customer Relationship Management, PeopleSoft Finance, and/or OBI enterprise applications.
  • Important: This is NOT a designation for payment of death benefits and refund of employee retirement contributions.
  • To enroll in Direct Deposit, complete this form.
  • Use this form ONLY to change payroll designee. Employee starts the Adobe Sign Workflow.
  • NOTE: USE THIS FORM FOR UPDATES ONLY- This form is required from the State and is used prior to employment or to make changes during employment, for determining exemption status for taxable deductions, and any other deductions sought. This form is also used for address & withholding changes.

Onboarding, Recruitment