Forms

When using Adobe Sign employees must use their Cal Poly email address. The use of personal emails will cause the document to be placed in an error folder and potentially lost.

Benefits

Adobe Sign Benefits Forms

Additional information regarding Adobe Sign can be found on the Cal Poly ITS webpage: Service Desk Website

• Enrollment Worksheet for Benefit Elections or Changes
  (Not for Open Enrollment (OE) Changes - OE changes must be made in MyCalPoly Portal)ADOBE SIGN
• ACA Enrollment Worksheet for Benefit Elections or Changes (Health Only) ADOBE SIGN
• Dependent Care/Health Care Reimbursement Account Enrollment Authorization Form
  (Not for Open Enrollment (OE) Changes - OE changes must be made in MyCalPoly Portal) ADOBE SIGN
• Domestic Partner Dependent Certification Form ADOBE SIGN
• Affidavit of Parent-Child Relationship ADOBE SIGN
• Submission of Confidential Information ADOBE SIGN
• VSP Premier Enrollment FormADOBE SIGN
• Benefits Accounts Receivable Authorization FormADOBE SIGN

Other Benefits Forms

• Claim form for HCRA/DCRA PDF
• Claim form for VSP vision plan - Out of Network Reimbursement website
• Claim form for VSP vision plan video display terminal PDF
• eBenefits Self-Service Electronic Signature Authorization Form PDF

Classification & Compensation

• Procedures and Form for the Request of an In-Range Progression PDF
• HR 120 Position Description rev. 10/24 MS WORD

Employment Actions

• HR 101 Staff/MPP Personnel Action Request Form rev. 02/23 MS WORD
• HR 101 Guidelines rev. 7/15 PDF
• HR 101-R Request for Rehired Annuitant Appointment - Staff/MPP rev. 02/23 MS WORD
• HR 101-S Additional/Concurrent Assignment Request with Form E rev. 02/23 MS WORD
• CSU Form SSA-1945 Statement Regarding Your Employment in a Job Not Covered by Social Security PDF

Employee Personnel File Review

• HR-Confidential Information Disclosure Form ADOBESIGN

Evaluation/Performance Appraisal

Performance Evaluation Online Submission Form

Please note that Adobe Sign should be used only for required final signatures and does not allow for any changes to the attached performance evaluation. Any and all drafts/changes should be shared and finalized between the employee and administrator prior to attaching the final document
Adobe Sign Online Submission Form

• Staff/MPP Employee Evaluation Cycle rev. 07/15 MS WORD
• MPP Performance Evaluation Form rev. 05/21 MS WORD
• HR 138 Staff Evaluation Form - UAPC CSUEU SETC SUPA C99 Protected rev. 05/21 MS WORD
• HR 138a Staff Employee Self-Evaluation MS WORD
• HR 140 Unit 4 Report of Employee Performance with instructions for completion MS WORD

Fee Waiver

Employee Fee Waiver Forms

• Individual Career Development Plan (ICDP) ADOBE SIGN
• Employee Fee Waiver Application ADOBE SIGN
• Employee Fee Waiver Course Modification ADOBE SIGN
• Paper Application for Non-Matriculated StudentADOBE SIGN

Dependent Fee Waiver Forms

• Dependent Fee Waiver Application ADOBESIGN
• HR 133d Disabled Dependent Benefit PDF
• HR 133e Affidavit of Eligibility for Economically Dependent Children PDF

Mandated Reporter

• Mandated Reporter - General Reporter Acknowledgement ADOBE SIGN
• Mandated Reporter - Limited Reporter Acknowledgement Form ADOBE SIGN
• Mandated Reporter Executive Order 1083, Penal Code Sections and Categories of Mandated Reporters

Outside Employment

Management Personnel Plan (MPP) Employees

• Outside Employment Disclosure and Acknowledgement Form ADOBE SIGN

Recruitment

For Hiring Department Information and Forms, please see Recruitment Information & Tools

Separation / Early Settlement

• AP 191 Faculty Notice of ResignationADOBE SIGN
• AP 191 Faculty Notice of Resignation PDF
• HR 191 Employee Notice of Resignation (not for transfers) ADOBE SIGN
• HR 191 Employee Notice of Resignation (not for transfers)PDF
• PR 300 Employee Separation Form MS WORD
• PR 192 Early/Final Settlement Authorization MS WORD
• Student Assistant Separation Checklist MS WORD

Leave of Absence

• HR 190 Application for Leave Without Pay for Staff/Management Employees & Procedures ADOBE SIGN
• HR 190 Application for Leave Without Pay for Staff/Management Employees & Procedures PDF
• HR 190 Application for Leave Without Pay for Staff/Management Employees & Procedures rev. 4/12 MS WORD

Telecommuting

• Telecommuting and Remote Work Guidelines for Staff and MPPsPDF
• Telecommuting and Remote Work Website

Covid-19 Forms

• Covid-19 Reporting Form for Staff and FacultyWebsite

Workers' Compensation

Workers' Compensation Forms