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	UPAY 585 (PDF)	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)	Conditional Benefits Packages
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: Campus Substance Abuse Policy Complete text of Policy Resources on Drugs and Alcohol and dealing with Substance Abuse			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