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The forms in this section are generally in Microsoft Word (.doc) or Portable Document Format (.pdf). PDF files can be viewed by using the Adobe Acrobat Reader, which is available free from the Adobe site. Adobe Reader 7.0 or higher is recommended.
Payroll forms, including Direct Deposit, are available on the Payroll website.
Benefits
Many benefits forms and publications can be found online or ordered from the KP Supply Warehouse.
Department Benefits Counselors (DBCs)
COBRA
Eligibility
- BELI Form (PDF)
Employment Events: Rehiring Retirees
- Retired Employee Approvals Form (PDF) (UBEN 138)
- UC Berkeley Supplement to the Retired Employee Approvals Form (PDF)
- UCRP Reemployed Retiree Notification Form (PDF) (UBEN 1039)
Health & Welfare Plans
Leaves
Rehiring UC Retirees
- Rehire Approvals Form (PDF) (UBEN 138)
- UCRP Reemployed Retiree Notification Form (PDF) (UBEN 1039)
- UC Berkeley Supplement to the Retired Employee Approvals Form (PDF)
Retirement & Retirement Savings Plans
Compensation & Classification
Job Standards / Job Description Templates
- Represented Job Description Template (Word) [non-represented employee job standards can be found on the Berkeley Job Builder]
- Staff Research Associate Positions addendum (Word)
Diversity & Inclusion
Demographic Data
- HCM Instructions (PDF)
- Transmittal Form (PDF)
Employee Relations
Background Check
- Employee/Applicant Release and Disclosure Form (PDF)
- Sample Notification Letters:
- New Hires (Word)
- Reclassification or Assignment of New Duties (Word)
- Transfers (Word)
Catastrophic Leave Sharing Program
Compensatory Time Off (CTO)
- See PPSM: Compensatory Time Off Form
- Labor Contracts
Counseling
- Letter of Counseling (Word)
Discipline
- Letter of Corrective Salary Decrease (In Lieu of a Suspension - after Reviewer has Responded) (Word)
- Letter of Demotion (After Reviewer has Responded) (Word)
- Letter of Final Warning (Word)
- Letter of Reviewer Designation (from Next Level Supervisor) (Word)
- Letter of Suspension (After Reviewer has Responded) (Word)
- Letter of Suspension (No Notice Required) (Word)
- Letter of Termination (After Reviewer has Responded) (Word)
- Letter of Warning (Word)
- Notice of Intent to Demote (Word)
- Notice of Intent to Suspend (Word)
- Notice of Intent to Take Corrective Salary Decrease (In lieu of a Suspension) (Word)
- Notice of Intent to Terminate (Word)
Family & Medical Leave Packet
- Certifications
- Medical Leave Form for Employees (PDF)
- Medical Leave Form for Family Member (PDF)
- Pregnancy Disability (PDF)
- Return to Work (PDF)
- Forms, Checklists and Facts
- Military Certifications
- Caregiver Leave (PDF)
- Qualifying Exigency Leave (PDF)
- Letters
- See sample letters on UCnet
- Other
Layoff
- PPSM
- Labor Contract
- Unemployment Insurance Letter (Word)
Medical Separation
- Notice of Leave of Absence and Special Placement Consideration (90 day transfer search) (Word)
- Request for Review (Campus Accommodation and/or Medical Separation) form (Word) - please review the instructions before filling out this form.
Military Leave
Miscellaneous Template Letters
- Letter of Downward Reclassification (Word)
- Letter to Extend Probationary Period (Word)
- Letter of Investigatory Leave (Word)
- Letter of (Lateral) Reassignment or Transfer (with Location or Supervisor Change) (Word)
- Letter to Release Employee from Limited Appointment (Word)
- Letter to Release Employee from Probationary Period (Word)
- Letter of Upward Reclassification (Word)
- Performance Improvement Plan (Word)
MSP Separation
- Notice of Intent to Separate MSP (position elimination)
- Notice of Intent to Reduce MSP Appointment Percentage
- Letter of MSP Separation (position elimination when employee responds)
- Letter of MSP Separation (position elimination when employee does not respond)
- Letter of MSP Reduction in Time (when employee responds)
- Letter of MSP Reduction in Time (when employee does not respond)
- Working Document [MSP]
Pregnancy Disability Leave (PDL)
- Employee FML Eligible (PDF) - For combined PDL and Parental Leave
- Employee FML Eligible (PDF) - For Requests Limited to PDL
- Employee FML Eligible but Leave Entitlement Exhausted (PDF) - For Requests for PDL only
- Employee Not FML Eligible (PDF) - For requests for PDL only
- Letter for Change in End Date of PDL (PDF) - For Approved Combined PDL and Parental Leave
- Medical Certification for Employee's Pregnancy Disability (PDF)
- PDL Confirmation Letter (PDF) - Employee Not FML Eligible or Employee FML Eligible but Leave Entitlement Exhausted
- Request to Continue/Cancel Benefits While on Leave (PDF)
- Return to Work Certification (PDF)
Telecommuting
Employment
Interview Data Form and Physical, Environmental, and Mental Demands (PEM) form
Labor Relations
Compensatory Time Off (CTO)
Contracts (forms and sample letters)
Payroll Deduction Authorization (Agency Fees)
Proof of Service
- Proof of Service Template (Word)
Learning & Development
Career Development
Performance Management
Non-Represented Staff Performance Review Forms
Represented Staff Performance Review Guidance and Forms
Records Management
Hiring Forms
- Hire/Rehire Required Forms Checklist
- Demographic Data:
- HCM Instructions (PDF)
- Transmittal Form (PDF)
- E-Verify (Instructions for departments) (Word) - Includes letter templates for existing and new employees
- I-9:
- UPAY 585–State Oath of Allegiance and Patent Agreement (PDF)
- W-4:
- Federal Withholding Form - Resident (Form UC W-4/DE 4) (PDF) - This form can be filled in electronically. Read notes on form about privacy.
- Federal Withholding Form - Nonresident (Form UC W-4NR/DE 4) (PDF) - This form can be filled in electronically. Read notes on form about privacy. More information on taxation forms for non-residents.
- Instructions for Entering W-4 Tax Allowances via At Your Service Online (PDF)
Retirement Gifts
- Request Form for Staff (Word)