Hire/Rehire Required Forms Checklist

Instructions:

Complete all forms as noted in the checklist below. Include Employee ID on all forms. Follow the instructions on where to send each form as stated below. You can print this checklist  (PDF) if you prefer.

 

Form

Distribution

Link

Hire

Rehire

State Oath of Allegiance

Keep in Department

UPAY 585  (PDF)

Required
US Citizens only
Conditional
US Citizens only

Patent Policy Acknowledgement

Keep in Department

Required – All Employees

Employment Eligibility Verification Form I-9

For departments that have transferred to CSS, I-9s should remain at CSS location on 4th Street.

All others send to:
Human Resources
Records Management
2199 Addison St., Room 192 (University Hall)
Mail Code 3540

Form I-9  (PDF download)

Required Conditional

Demographic Data Transmittal

Destroy after data entry into HCM

U5605  (PDF)

Required Conditional

UC Federal/State Withholding Allowance Certificate
UC W-4/DE 4 

Option 1: Employees log in and complete online

Option 2: complete form, fax to:
CSS - HR
FAX: (510) 642-1882 

At Your Service Online

UC W-4DE 4  (PDF)

Required

Conditional

UC Federal-State Non
Resident Alien Withholding Allowance Certificate
UC W-4NR/DE 4

Complete form, fax to:
CSS - HR
FAX: (510) 642-1882 

UC W-4NR/DE  (PDF)

Required

Conditional

Payroll Earnings Distribution Authorization (Direct Deposit)

Self Service
Form not required
 
Keep Form in Department
 

BLU Self Service

UPAY 544A-1  (PDF)

Required

Conditional

Benefits Eligibility Level Indicator (BELI) and Status Qualifier Code (SQC)

Keep in Department

UPAY 726  (PDF)

Required

Understanding Eligibility

 

Health and Welfare Plans

Employees log in and enroll in health and welfare plans online. If unable to enroll online, use form.

At Your Service Online

UPAY 850  (PDF)

Conditional

Benefits Packages

Flexible Spending Account

Employees log in and enroll online. If unable to enroll online, use form.

At Your Service Online

UPAY 850  (PDF)

GLACIER

Departments with admin rights initiate process through:
Arctic International log in

Departments without admin rights initiate process though:
Initial Glacier Info

Employee completes online information, prints & mails required documents from Glacier tax summary report to:

Central Payroll
GET NEW ADDRESS
Mail Code 1104

Glacier

 

 Required

Conditional

Statement Employment not Covered by Social Security  

UC HR/Benefits
Records Management
P.O. Box 24570
Oakland, CA 94623-1570

UCRS 419  (PDF)

Conditional

Conflict of Interest for Public Officials

Send to: Natasha Williams
1111 Franklin Street, 8th Floor
Oakland, CA 94607-5200

Form 700

Conditional

Designated Positions  (PDF)

UC Policy on Substance Abuse to comply with Federal Drug Free Workplace Act.
Print the following documents at the links shown, give to the employee, and check the box that you have done so: 

Required

Workers’ Compensation Pamphlet: Time of Hire

Print the following documents and follow the instructions:

  • Instructions and Acknowledgment Form
  • Pamphlet

Keep in Department

Instructions & Acknowledgement Form  (PDF)

Pamphlet (English version)  (PDF)

Pamphlet (Spanish version)  (PDF)

Required