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Employee Services
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Forms
Catastrophic Leave Donation Form
Catastrophic Leave Request Form
Employee-initiated Reduction In Time (ERIT) Contract - 7/1/12–6/30/14
Individual Development Plan Form
Medicare forms on At Your Service
Tax Withholding Election for UCRP Income
Unemployment Insurance Termination Report (U5602)
Benefits
All forms and worksheets on UCnet
Benefits Enrollment/Change Form (UPAY 850)
Leave of Absence Request form
Maternity Leave Counselling Checklist
Membership Application - Emeriti Association
Membership Application - Retirees Assocation
Notice to UC of a COBRA Qualifying Event (UBEN 109)
Compensation
Analyst Questionnaire
Business Officer/MSO Questionnaire
CNT Information Systems & Software Engineer Questionnaire
CNT Information Systems and Software Engineer Matrix
CNT Systems & Network Administrators Questionnaire
Contracts and Grant Questionnaire
CX/Teamsters Time Election Form
Employee Flex Schedule Agreement Form
Employee Self-Assessment Form
Graduate Advisor Questionnaire
HX/UPTE Comp Time Election Form
Job Description Template
Non-Exempt Non-Represented Election Form
NX/CNCANomp Time Election Form
Performance Eval Form- Non-Represented Staff (Type-In)
Performance Eval Form Non-Represented Staff (Write-In)
Performance Eval Form Represented Employee
Performance Goals and Objectives Form
Probationary Period Report Form
RX/UPTE Comp Time Election Form
SAO Questionnaire
SX/AFSCME Comp Time Election Form
TX/UPTE Comp Time Election Form
Undergraduate Advisor Questionnaire
Vacation Policy Request for Exception Form
Disability
Certificate of Health Care Provider for Employee’s Pregnancy Disability
Certificate of Health Care Provider for Employee’s Serious Health Condition
Certificate of Health Care Provider for Family Member’s Serious Health Condition
Certificate of Healthcare Provider non-FML
Certification for Military Caregiver Leave
Certification for Qualifying Exigency Leave
Consent for the Disclosure and Use of Health Care/Vocational Information and Records (UCRS
158) for Liberty Mutual
Consent for the Disclosure and Use of Health Care/Vocational Information and Records (UCRS
158) for Sedgwick
Consent for the Disclosure and Use of Health Care/Vocational Information and Records (UCRS
158) for UCSB
Declaration of Relationship
Designation Notice
Employee Request for Reasonable Accommodation
FML Exempt Employee Workweek Agreement
FML Usage Tracking Calculator
Leave of Absence Request form
Liberty Mutual Attending Physician's Statement
Liberty Mutual Department Statement
Liberty Mutual Disability Claim Form
Liberty Mutual Disability Claim Form - Spanish
Liberty Mutual Reporting Your Disability Claim Online
Maternity Leave Counselling Checklist
Medical Response for a Reasonable Accommodation Request
Notice of Eligibility and Rights & Responsibilities
Preliminary Request for Medical Separation
Reasonable Accommodation Agreement
Return to Work Certification
Return to Work Certification non-FML
Transitional Work Program Agreement
UCRP Application for Disability Income (UCRS 156
UCRP Background Information Sheet
UCRP Consent for the Disclosure and Use of Health Care/Vocational Information and Records
(UCRS 158)
UCRP Direct Deposit of Monthly Benefit (UCRS 160)
UCRP Request for Medical Information for Disability Income (UCRS 159)
UCRP Retiree Continuation, Enrollment or Change - Medical, Dental and/or Legal Plan (UBEN
100)
Work Status Form
Employee Services
ASAP Intake Forms
Maternity Leave Counselling Checklist
Employment
Above 25% (Min of Range) Request Form
Above Midpoint Hire Request Form
Background Check - Fingerprint Authorization Form - Form A
Background Check Authorization to Release Information Form - Form C
Background Check Form - Form B (English)
Background Check Form - Form B (Spanish)
CANRA Acknowledgement Form
Coach Contract Amendment Template - Revise End Date
DMV Employer Pull Notice Program - Employee Notice
DMV Employer Pull Notice Program - Enroll/Delete Form
DMV Employer Pull Notice Program - Notice of Point Assignment
Dual Employment Request Form
Employee Flex Schedule Agreement Form
Employment Contract Template - Amendment
Employment Contract Template - MSP Development Officer (DO)
Employment Contract Template - MSP Coach
Employment Contract Template - MSP General Use
Employment Contract Template - MSP Physician (PH)
Employment Contract Template - PSS Coach (Non-Exempt)
Employment Contract Template - PSS Coach (Exempt)
Employment Contract Template - PSS General Use (Exempt)
Employment Contract Template - PSS General Use (Non-Exempt)
Employment Contract Template - PSS Resident Advisor (Non-Exempt)
Employment Contract Template - PSS Sr Resident Advisor (Exempt)
Employment of a Near Relative Request Form
Job Description Template
List of Mandated Reporters with Signed Certifications Report
New Hire Checklist
Overtime Pay Instructions for Dual Employment
Probationary Period Report Form
Retention of Near Relative Employees Request Form
Retired Employees Approval Form
Statement Acknowledging Requirement to Report Child Abuse
Telephone Reference Check
Temporary Intercampus or Multicampus Appointment Form (UPAY 560-T)
UCSB Home Safety Checklist for Telecommuters and Remote Workers
UCSB Remote Worker Agreement Template
UCSB Supervisor's Checklist for Telecommuters and Remote Workers
UCSB Telecommuter Agreement Template
UCSB Receipt of University Equipment
Voluntary Self-Identification of Disability Form (Form CC305)
Voluntary Self-Identification of Race, Ethnicity and Veteran Status Form (U5605)
Waiver of Open Recruitment Request Form
PPS + UC Path
PPS Request for Access Form
Request for Service Credit Review Form
Request for Verification of Previous Employment Form
Training
Dilling Yang Staff Scholarship Application Form with Guidelines
Reduced Fee Enrollment Application
Human Resources Department
University of California, Santa Barbara
3101 Student Affairs and Administrative
Services Building (SAASB)
Santa Barbara, CA 93106-3160
Hours: 8:00 - 12:00 and 1:00 - 4:00
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