Evaluations
Academic Employees, Evaluations
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Updated April 2022.
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The Professional Development Plan (PDP) is a flexible document that reflects the strengths of the candidate and her/his professional development goals.
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For use by Lecturers seeking Range Elevation
Benefits
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Attach supporting documentation and submit to ASIFlex
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Request for Non-Emergency Medical Transportation for Work-Related Injuries
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A Cal-Ore Life Flight membership ensures the patient will have no out-of-pocket flight expenses if flown by the Company or another AirMedCare Network participating provider
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Career Development Plans use an online submission process which provides the opportunity to sign, gain signatures and submit electronically.
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Employee’s Report of Injury (DWC-1) – Must be given to employee at the time injury is reported to Supervisor, or as soon as possible after medical treatment is received
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Predesignation of a Personal Physician
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This booklet contains information and a payment application to help you select the payment method that best meets your needs.
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Employee will need to initiate the form and send it to supervisor for review/approval. Supervisor will need to send the completed form to Ariel.Aaron@humboldt.edu. Please make sure the time is also claimed in Absence Management or claimed on the employee's timesheet
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Supervisor’s Report of Injury – MUST BE SUBMITTED TO HUMAN RESOURCES WITHIN 24 HOURS OF KNOWLEDGE OF INJURY
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Employer Paid Life and AD&D Beneficiary Designation and Change Form
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The VSP Video Display Terminal (VDT) Confirmation Form is only provided to CSU employees who meet the necessary job requirements as determined by the CSU campus benefits office. This form must be completed by the employee and provided to a VSP Select Network doctor to receive the supplemental VDT benefit.
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This is an Adobe Sign Form. You will need to log in with your Humboldt username account. Follow the instructions in the landing page.
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The document includes links to all the necessary forms for the Workers' Compensation process.
Academic Employees, Benefits
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Available to eligible faculty unit employees only.
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Available to eligible faculty unit employees only.
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Tenured Faculty Unit employees who are of normal retirement age (consistent with CalPERS rules and pursuant to the California Code of Regulations (CCR) §586.1) are eligible to participate in the program.
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Notary Pages for Approved Sabbatical and DIP Leaves
Equal Opportunity and Compliance
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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.
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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.
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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.
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Acknowledgement of Mandated Reporter Status and Legal Duty to Report Child Abuse and Neglect (EO 1083)
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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.
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Child Abuse Reporting Form
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To Be Completed by Mandated Child Abuse Reporters Pursuant to Penal Code Section 11166
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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.
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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.
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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
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Apply for an original Social Security card, apply for a replacement Social Security card, change or correct information on your Social Security number record
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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.
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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.
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Important: This is NOT a designation for payment of death benefits and refund of employee retirement contributions.
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To enroll in Direct Deposit, complete this form.
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Use this form ONLY to change payroll designee. Employee starts the Adobe Sign Workflow.
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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.
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