Many of these forms are in Adobe PDF or Microsoft Word format. If you are experiencing problems when trying to open any of these forms, please visit the download links provided here to obtain the latest versions of the reader software.
NEW: Many Human Resources forms can now be submitted online through DocuSign. Please click on the desired link to begin the process. Additional information regarding DocuSign can be found on the Cal Poly ITS webpage: Service Desk Website
DocuSign Benefits Forms
- Affidavit of Parent-Child Relationship [DocuSign]
- Dependent Care/Health Care Reimbursement Account Plans Enrollment Authorization Form [DocuSign]
- Domestic Partner Dependent Certification Form [DocuSign]
- Enrollment Worksheet for Benefit Elections or Changes [DocuSign]
- Declaration of Health Coverage - HBD 12-A [DocuSign]
PDF Benefits Forms
- Affidavit of Parent-Child Relationship for health coverage [pdf]
- Changing Your Beneficiary [pdf]
- Claim form for HCRA/DCRA [pdf]
- Claim forms for PERS Choice, PERS Select, PERS Care plans [pdf]
- Claim form for VSP vision plan - Out of Network Reimbursement [pdf]
- Claim form for VSP vision plan video display terminal (computer glasses)[pdf] (for employees working on a computer 4 or more hours per day)
- Domestic Partner Tax Dependent Certification [pdf] rev. 12/04
- Enrollment Worksheet for Benefit Elections and/or Changes [pdf fill-in].
- ACA Enrollment Worksheet for Benefit Elections and/or Changes [pdf fill-in].
- eBenefits Self-Service Electronic Signature Authorization Form [pdf fill-in].
- HBD-12A Enrollment Changes Authorization [pdf fill-in].
- Enrollment form for HCRA/DCRA plans [pdf] To allow for adequate processing time, please have any HCRA or DCRA enrollments in to the Benefits Department by the 3rd of the month.
- Voluntary Life Insurance Enrollment, Beneficiary, Claim and Conversion Forms through The Standard.
Classification & Compensation
- Procedures and Form for the Request of an In-Range Progression [Word] rev. 09/12
- HR 120 Position Description [Word] rev. 5/15
Employee Information Update
- Employee Self Service
- Personal Data Form [Word] Personal Data Form [pdf] rev. 11/13
- Designation of Person Authorized to Receive Warrants[pdf] Must be submitted to Human Resources in person with picture ID.
- HR 101 Staff/MPP Personnel Action Request Form [Word] rev. 3/16
- HR 101 Guidelines [pdf] rev. 7/15
- HR 101-R Request for Rehired Annuitant Appointment - Staff/MPP [Word] rev. 10/13
- HR 101-S Additional/Concurrent Assignment Request with Form E [Word] rev. 10/13
- CSU Form SSA-1945 Statement Regarding Your Employment in a Job Not Covered by Social Security [pdf]
- Staff/MPP Employee Evaluation Cycle [Word] rev. 04/17
- New MPP Performance Evaluation Form [Word] rev. 04/17
- HR 138 Staff Employee Performance Evaluation [pdf] & HR 138 Staff Employee Performance Evaluation [Word] rev. 07/15 rev. 07/15
- HR 138a Staff Employee Self-Evaluation [Word] & HR 138a Staff Employee Self-Evaluation [PDF] rev. 07/15
- HR 140 Unit 4 Report of Employee Performance with instructions for completion [Word]
Employee Fee Waiver Forms
- Individual Career Development Plan (ICDP) [DocuSign]
- Employee Fee Waiver Application [DocuSign]
- Employee Fee Waiver Course Modification [DocuSign]
- Undergraduate Paper Application [pdf]
- Graduate Paper Application [pdf]
Dependent Fee Waiver Forms
- Dependent Fee Waiver Application [DocuSign]
- HR 133d Disabled Dependent Benefit [pdf]
- HR 133e Affidavit of Eligibility for Economically Dependent Children [pdf]
Previous Fee Waiver Forms
- Dependent Fee Waiver Application (previous version) (Word)
- Employee Fee Waiver Application (previous version) (Word)
- Employee Fee Waiver Course Modification (previous version) (Word)
- Individual Career Development Plan (ICDP)(previous version) (Word)
- Outside Employment Disclosure and Acknowledgement Form Management Personnel Plan (MPP) Employees [pdf] rev. 10/14.
- Voluntary Self-Identification of Disability Form [pdf]
- For Hiring Department Information and Forms, please see Recruitment Information & Tools.
Separation/Leave of Absence/Early Settlement
- HR 190 Application for Leave Without Pay for Staff/Management Employees & Procedures [DocuSign]
- Forms relating to Resignations, Faculty Early Settlement Authorization and Retirement can be found on the Separating & Retiring Employees.