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Form |
Description |
Campus |
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Academic Student Employee Letter | Academic departments use this template to write a letter to send to potential new employees. Submit to: ELR Department |
UC Davis | ||
Access Regulations for Employee Organizations at UC Davis Health |
Regulations governing the use of UC Davis Health System facilities and access to university employees by employee organizations and their representatives. |
UC Davis Health | ||
Access Violation Report | Department fills out form when employee organizations commit unauthorized or illegal actions. Submit to: ELR Department |
UC Davis | ||
Background Check Authorization to Release Information (Live Scan) |
Certain positions at UC Davis and UC Davis Health require a successful background check as condition of employment/assignment. | UC Davis/UC Davis Health | ||
Background Check Authorization to Release Information Form (Universal) | Certain positions at UC Davis and UC Davis Health require a successful background check as condition of employment/assignment. | UC Davis/UC Davis Health | ||
Background Check Worksheet | For department heads to list reasons for background check. Submit to: Hiring Manager |
UC Davis / UC Davis Health | ||
Career Ladder Voluntary Reassignment |
This form is to request a voluntary reassignment from Clinical Nurse III to the classification of Clinical Nurse II. |
UC Davis Health | ||
Catastrophic Leave - Permission to Release Medical Records (Exhibit A) | In the event that an employee has donated their leave to a colleague, this form allows the university to release a general medical description to support the employee's catastrophic leave request. Submit to: Department Supervisor, Manager or Chief Administrative Officer |
UC Davis/ UC Davis Health | ||
Catastrophic Leave - Request for Donations (Exhibit B) | Form through which employees can donate leave time to fellow employees who have exhausted their personal leave options. Submit to: Department Employees |
UC Davis/ UC Davis Health | ||
Catastrophic Leave - Donation Form (Exhibit C) | Form through which employees who wish to donate their accrued vacation leave to colleague who have exhausted their own leave options. Submit to: Department Supervisor, Manager or Chief Administrative Officer |
UC Davis/ UC Davis Health | ||
Child Abuse and Neglect Reporting Act (CANRA) Acknowledgment Form | Employees must sign this statement if they're deemed a “mandated reporter” under CANRA/Presidential Policy on Reporting Child Abuse and Neglect (See Appendix A-Mandated Reporter Categories. All UCD Health hires are mandated reporters). Submit to: Service Channel |
UC Davis / UC Davis Health | ||
Classification Review Request | Complete to request a classification review. Submit to: Compensation Department - Compensation Analyst |
UC Davis Health | ||
Cognos Report/UCPath Access Request Form |
Departments use this online form to request employees be provisioned access to Cognos Reports and/or UCPath security roles. Visit the local UCPath Security webpage for instructions on using the form and a list of Security Liaisons. |
UC Davis / UC Davis Health | ||
Compensatory Time Notification Form (CX Unit) (Davis Campus Only) |
Allows employees in the Clerical and Allied Services Unit (CX) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Compensatory Time Notification Form (EX Unit) (Davis Campus Only) |
Allows employees in the Patient Care Technical Unit (EX) to elect how they receive compensation for overtime.
Submit to: Original to Supervisor, copy to Employee For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee.
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UC Davis | ||
Compensatory Time Notification Form (F3 Unit) (Davis Campus Only) |
Allows employees in the Fire Fighter Unit (F3) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Compensatory Time Notification Form (HX Units) (Davis Campus Only)
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Allows employees in the Health Care Professionals Unit (HX) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Compensatory Time Notification Form (Non-Represented Staff) (Davis Campus Only) |
Non-exempt employees on the Davis campus are entitled to either Over Time or Compensatory Time Off (CTO). Comp. Time is allowed at the manager’s discretion. This form allows the employee to opt for CTO in lieu of OT if approved.
Submit to: Create AggieService ticket, upload form to ticket, shared services will make the adjustment.
For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee.
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UC Davis | ||
Compensatory Time Notification Form (RX Unit) (Davis Campus Only) |
Allows employees in the Research Support Professionals Unit (RX) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Compensatory Time Notification Form (SX Unit) (Davis Campus Only) |
Allows employees in the Service Unit (SX) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Compensatory Time Notification Form (TX Unit) (Davis Campus Only) |
Allows employees in the Technical Unit (TX) to elect how they receive compensation for overtime. For all UC Davis Health employees, supervisors and managers are responsible for identifying eligible employees under UCDH Policy 2920 (CTO Accrual for Eligible Employees) and obtaining approval for CTO enrollment from Employee and Labor Relations. Once eligibility has been confirmed, Payroll will create a CTO bank for the employee. |
UC Davis | ||
Conditional Offer of Employment Template | Supports departments when offering an appointment that is contingent upon a successful background check. Submit to: Prospective employee |
UC Davis / UC Davis Health | ||
Course Roster for Training | To be used to record in-service educational training at UC Davis Health. Submit to: Training and Development at HS-T@ucdavis.edu |
UC Davis Health | ||
Demographic Data | Complete this form to provide demographic information for employment. Submit to: Shared Services Organization, Recruitment coordinators |
UC Davis Health | ||
Direct Deposit Election | Allows new and rehires to provide banking information for e-direct deposits. Submit to: Shared Services Organization, Recruitment Coordinators |
UC Davis Health | ||
Elder and Dependent Adult Abuse - Employee Notification | Certain employees are mandated reporters and must sign this form prior to employment. Hiring departments are required to complete this form during onboarding. Submit to: Local HR office |
UC Davis / UC Davis Health | ||
Emergency Payroll Advance Request | For employees to request an advance on their earnings for any personal emergency reasons. Submit to: Workers Compensation |
UC Davis Health | ||
Employee Complaint Form | Allows PSS and MSP employees to file an official complaint. Submit to: ELR Department |
UC Davis / UC Davis Health | ||
Employee Development Worksheet | Supervisors use this form for employee evaluations that are not part of the annual performance appraisals. Submit to: Central HR for scanning; copy given to employee |
UC Davis | ||
Employee Separation | Complete this form when an employee is separating. Submit to: Shared Services Organization, UC Davis Health Records Unit |
UC Davis Health | ||
Employee-Student Fee Reduction Authorization | For employees who are eligible to receive reduced fees. Submit to: Obtain the required signatures, then send to the Office of the Registrar by the 10th day of instruction. |
UC Davis / UC Davis Health | ||
Employee Time Record | Employees can fill out this form to record hours worked prior to online TES/Ecotime account activation. Submit to: Payroll |
UC Davis / UC Davis Health | ||
Employment Eligibility Verification Form (Form I-9) | This form is used to verify the identity and legal authorization to work of all paid employees in the United States. Submit to: Retain in HR personnel file |
UC Davis / UC Davis Health | ||
Equity Adjustment Request | This form may be used for any internal department or division approval processes. A formal request to Compensation Services must be submitted via PeopleAdmin at ucdavis.peopleadmin.com/hr/ |
UC Davis Health | ||
Exceed Maximum Vacation Accrual Limit Request | Managers and employees can use this form to when the employee exceeds the vacation accrual threshold. Submit to: Department Head, then ELR |
UC Davis | ||
Flexible Work Arrangements - Policies & Application (Davis Campus) |
Learn about the various flexible work options and use the proposal form to request a flexible work schedule.
Please refer to the Campus Ready/Workplace Reimagined website for instructions and current forms. |
UC Davis | ||
Flexible Work Agreement (UC Davis Health) |
Use the Flexible Work Agreement form when employees will work 100% onsite but have a flexible schedule.
Please refer to the Digital Workplace Program website for more information on remote work arrangements. |
UC Davis Health | ||
FMLA Certification of Health Care Provider for Employee's Own Condition | For employees requesting FML or CFRA for themselves, this form documents their qualifying condition. Submit to: After completion by employee, family member, and family member's health care provider; then submit to department personnel |
UC Davis / UC Davis Health | ||
FMLA Certification of Health Care Provider for Family Member | For employees requesting FML or CFRA to care for a family member, this form documents the family member's qualifying condition. Submit to: After completion by employee, family member, and family member's health care provider; then submit to department personnel |
UC Davis / UC Davis Health | ||
FMLA Certification for Leave Arising out of Active Duty | For employees requesting FML for a covered military member being called to active duty. Submit to: Department |
UC Davis / UC Davis Health | ||
FMLA Military Caregiver Leave Certification | Employees are Eligible for protected leave to care for the serious injury or illness of a covered service member. Submit to: Department personnel |
UC Davis / UC Davis Health | ||
FMLA Declaration of Relationship | Employees are eligible for family medical leave for certain life events that impact relatives. This form helps ensure the relationship is FML eligible. Submit to: Department personnel |
UC Davis / UC Davis Health | ||
FMLA Employee Checklist | Helps employees work through the process of requesting family medical leave for certain life events. Submit to: For employee use only. |
UC Davis | ||
FMLA Request Department Checklist | Helps departments who aren't under a Shared Services Center to manage employee leave requests. Submit to: For department use only. |
UC Davis | ||
FMLA Return to Work Certification | Employee completes with health care provider and returns completed form to their department, allowing employee to return to work after FML. Submit to: Employee completes with health care provider and returns completed form to their department. |
UC Davis / UC Davis Health | ||
FML, CFRA, Pregnancy Disability Leave (PDL) Designation Notice | Allows departments to document if an employee's FML, CFRA, or PDL request has been approved. Submit to: Department completes form and submits to employee. |
UC Davis / UC Davis Health | ||
FML/PDL Intermittent Tracking Form |
Assists departments in tracking intermittent usages of family medical leave (FML) or pregnancy disability leave (PDL).
Submit to: For department use only |
UC Davis / UC Davis Health | ||
Interactive Process Documentation Form | This form is used to document an Interactive Process meeting. To obtain this document, please send an email to dmshelp@ucdavis.edu. | |||
Internal Recruitment Request Form |
Hiring managers fill out form in collaboration with their Talent Acquisition Partner (TAP) to request an internal recruitment for a career appointment. |
UC Davis / UC Davis Health | ||
Interview Committee Guide | For Hiring Departments to use during the interview process. |
UC Davis | ||
Labor Pool Assistance Request | Complete to request labor pool assistance. Submit to: ELR Department |
UC Davis Health | ||
Labor Pool Available Staff | Use this form to collect information about employees who are available for the labor pool. Submit to: Fax to 916-734-3080, attention Labor Pool |
UC Davis Health | ||
Leave of Absence Request | Form that UC Davis Health employees can use to request an extended leave of absence for certain life events. Submit to: Manager and/or department personnel liaison. |
UC Davis Health | ||
Live Scan Form (HR) | To be completed by hiring department and provided to applicant/employee | UC Davis/UC Davis Health | ||
Mandated Reporter Form | All UC employees are mandated reporters of any suspected child abuse. This form requires the employee’s signature and informs them of the responsibilities related. Submit to: Copies to Department personnel file and HR personnel file |
UC Davis / UC Davis Health | ||
Mandatory Employment Notices/Posters | List of required federal and state employment notices/posters that is maintained by UC Office of the President with links to each notice/poster. | UC Davis / UC Davis Health | ||
The Meal Period Waiver form is used to waive meal periods for employees that are required to have meal and rest periods in accordance with California Labor Code section 512.1. The Missed Meal and Rest Break Form is used to document if an employee is unable to take their meal or rest break due to an operational requirement or constraint. |
UC Davis Health | |||
Medical Separation Review | Department uses form to begin the Medical Separation process. Submit to: Disability Management Service |
UC Davis / UC Davis Health | ||
MSP Contract Agreement | Assists Hiring Departments by defining policies and expectations for hiring managers and senior professionals on contract. Submit to: Local HR office |
UC Davis / UC Davis Health | ||
MSP Employee Summary of Accomplishments | This form is used to evaluate the performance of Managers and Senior Professional staff at UC Davis Health. Submit to: Completed and submitted as part of the annual performance appraisal. |
UC Davis Health | ||
MSP Physician Contract | Physicians complete this contract at time of employment. Submit to: Hiring Manager |
UC Davis Health | ||
MSP Position Description Form | The official outline to support hiring departments in writing a new position description for managers and senior professionals at UC Davis Health. Submit to: Recruitment |
UC Davis Health | ||
Near Relative Request for New Hire | UC Policy defines and regulates employment relationships between near relatives. This form allows hiring departments to submit a request for a near relative hire. Submit to: Local HR office |
UC Davis / UC Davis Health | ||
Near Relative Request for Relationship Change | UC Policy regulates employment relationships between near relatives. This form allows departments to submit a request for change of relationship between employees. Submit to: Local HR office |
UC Davis / UC Davis Health | ||
New Employee Checklist | UC Davis supervisors to complete during onboarding process. Submit to: Share completed list with employee and keep in department files. |
UC Davis | ||
New Employee Checklist | UC Davis Health supervisors to complete during onboarding process. Submit to: Share completed list with employee and keep in department files. |
UC Davis Health | ||
Non-Financial Leave Hours Adjustment | For Department personnel liaisons and payroll to submit form to adjust an employee’s leave hours. Submit to: Payroll |
UC Davis / UC Davis Health | ||
No Physical Access Verification (Campus only) |
This form verifies and confirms that an employee is not required or expected to physically access a University Location or Program for any work, research, or education/training related purpose, and therefore is not a Covered Individual subject to the requirements of the UC Policy on Vaccine Programs for the period of time indicated below. | UC Davis Campus | ||
Notice of Intent to Change Conditions of Employment | Departments use this form to notify HR of changing employment conditions, HR then notifies the Union. Submit to: ELR Department |
UC Davis / UC Davis Health | ||
OnBase Form | Complete to record a leave of absence. Submit to: Shared Services Organization, UC Davis Health Records Unit |
UC Davis Health | ||
Online Earnings Statement Exception | Complete if you are requesting to receive a paper Direct Deposit Earnings Statement or you are cancelling a previous request for a paper Direct Deposit Statement and now want to view your statement online. Submit to: Payroll Services Office, or fax to 530-757-8597 |
UC Davis / UC Davis Health | ||
Pay Status During Leave | UC Davis Health employees should use this form to indicate their pay status during leave. Submit to: LOA Services Department/UCDH | UC Davis Health | ||
Payroll Address Change | Allows employees to notify of an address change to receive paychecks and statements. Submit to: UC Davis Health Payroll |
UC Davis Health | ||
Payroll Checks through Mail | Complete to request your payroll checks to be delivered through the mail. Submit to: UC Davis Health Payroll |
UC Davis Health | ||
PDL Certification of Health Care Provider | This form provides the medical certification to support your request for PDL due to pregnancy, childbirth, or related medical condition.
Submit to: After completion by employee and health care provider; then submit to department personnel. |
UC Davis / UC Davis Health | ||
Permanent Accommodation |
This form is used by both campus and health managers and supervisors to document a permanent accommodation. Managers & Supervisors using the fillable PDF, submit to: Disability Management Services at melwells@ucdavis.edu. For questions on the DocuSign or PDF form please email melwells@ucdavis.edu. Here are helpful FAQ's for DocuSign. |
UC Davis / UC Davis Health | ||
Personal Data (UPAY 544) | Provide necessary employment information for payroll and personnel matters. Submit to: UCOP Payroll |
UC Davis / UC Davis Health | ||
Personal Data (UPAY 544A for Union Workers) | Union workers provide necessary employment information for payroll and personnel matters. Submit to: UCOP Payroll |
UC Davis / UC Davis Health | ||
Position Closure Proposal | Complete form to initiate an indefinite position closure proposal. Submit to: ELR Department |
UC Davis Health | ||
Position Closure Special Skills Addendum | Because position closure occurs in reverse seniority order, less senior employees inform departments of special skills that may prevent layoff. Submit to: Compensation/Classification |
UC Davis Health | ||
Position Description - How to Write | This form is for Managers, Supervisors & their administrative staff and gives specific directions for completing a position description form and explains details of the approval process when recruiting or modifying. | UC Davis Health | ||
Position Description Form | The official outline for writing a new position description. Submit to: Compensation/Classification |
UC Davis Health | ||
Position Not Covered by Social Security | Fill out this form to notify an employee who is not covered by Social Security about the potential effects on future benefits. Submit to: UCOP |
UC Davis / UC Davis Health | ||
Pre-Action Review Protocol | This protocol is for use in pre-disciplinary action reviews. | UC Davis / UC Davis Health | ||
Probationary Period - Change End Date (Health Campus) |
Managers and Supervisors can complete this form to request to change an employee’s probationary period end date. Submit to: HR Administration |
UC Davis Health | ||
Probationary Period - Change End Date (Davis Campus) |
Managers and Supervisors can complete this form to request to change and employee's probationary period end date. |
UC Davis | ||
Probationary Period Report | Managers and Supervisors complete this PPSM form at the end of a probationary period. Submit to: Employee Relations Consultant |
UC Davis / UC Davis Health | ||
PSS Contract Agreement (exempt) | Defines policies and expectations for hiring exempt professionals and support staff on contract. Submit to: Hiring departments complete during onboarding and submit to local HR office. |
UC Davis / UC Davis Health | ||
PSS Contract Agreement (non-exempt) | Defines policies and expectations for hiring non-exempt professionals and support staff on contract. Submit to: Hiring departments complete during onboarding and submit to local HR office. |
UC Davis / UC Davis Health | ||
Property Recovery & Access Termination | Supervisors acknowledge that they have recovered University property and revoked University systems access for separating employees. Submit to: UC Davis Health HR Records |
UC Davis Health | ||
Request for Staff Records Form | Complete to request the personnel records of current staff members. Submit to: hrrecords.dist@ucdmc.ucdavis.edu. |
UC Davis Health | ||
Retired Employee Approvals Form | For managers looking to hire, or extend an appointment for a retired employee and outlines the specific reemployment regulations for individuals who receive a retiree benefit. Submit to: Local HR office at time of rehire |
UC Davis / UC Davis Health | ||
Screening Criteria Grid | Use to screen candidates and identify who to advance to interview. Submit to: Recruiter |
UC Davis Health | ||
Separation Checklist | A checklist of employee and supervisor responsibilities when an employee separates. Submit to: For employee and supervisor use only. |
UC Davis Health | ||
Separation Checklist for Supervisors | A checklist of responsibilities when a supervisor separates. Submit to: For supervisor use only. |
UC Davis Health | ||
Staff Leave Request | Staff may use form to request leave using vacation, sick, comp time, leave without pay, supplemental family medical leave, or personal leave. Submit to: Department Manager |
UC Davis | ||
STAR Plan Nomination Form | Managers and Supervisors can complete this form to nominate someone for the Star Recognition program. Submit to: Executive Director, then to Vice Chancellor |
UC Davis | ||
DMS: Steps to the Interactive Process | This is a tool for managers and supervisors to document the Interactive Process. Also refer to the "Reasonable Accommodation." To obtain this document, please send an email to dmshelp@ucdavis.edu. | |||
Stipend Request | Complete to request a stipend. Submit to: Compensation/Classification |
UC Davis Health | ||
Student Compaction |
Please use this template when you are submitting more than 1 Student Compaction due to the 2022 California Minimum Wage Increase:
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UC Davis/ UC Davis Health |
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Supplement to Military Pay |
Active duty military personnel can receive supplemental compensation. |
UC Davis / UC Davis Health | ||
Telephone Reference Checklist | Use this form to help conduct a pre-hire reference check. Submit to: Keep completed form with candidate's application packet. |
UC Davis / UC Davis Health | ||
Temporary Accommodation |
This form is used by managers and supervisors to document temporary accommodation. Campus: Managers & Supervisors using the fillable PDF, submit to: Disability Management Services at melwells@ucdavis.edu. Health: Managers & Supervisors using the fillable PDF, submit to: Disability Management Services at kkjlee@ucdavis.edu. For questions on the campus form please email melwells@ucdavis.edu or for health questions kkjlee@ucdavis.edu. Here are helpful FAQ's for DocuSign. |
UC Davis / UC Davis Health | ||
TES Assignment Request | Departments complete this form to request temporary employment services (TES). Submit to: Temporary Employee Services |
UC Davis / UC Davis Health | ||
UBEN 109 Notice to UC of a COBRA Qualifying Event | Use this form to notify the UC of the occurrence of a qualifying event that results in the involuntary loss of eligibility for coverage under the UC group insurance plans. | UC Davis / UC Davis Health |
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UBEN 109A Notice of Employee COBRA Qualifying Event | Department personnel may use this form to notify the Benefits Office of the occurrence of a non-separating qualifying event that results in the involuntary loss of eligibility for coverage under the UC group insurance plans. | UC Davis / UC Davis Health |
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UBEN 116 Designation of Beneficiary-Employees | Current employees may use the At Your Service Online website to name or change beneficiary(ies) for death benefits from the UC-sponsored retirement/savings and insurance plans in which you are enrolled (other than 403(b) Fidelity and Calvert mutual fund accounts). If unable to use the web, the employee may complete this form. (Submit form to UC/HR Benefits address on form.) | UC Davis / UC Davis Health |
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UBEN 119 Expanded Dependent Life and AD&D Insurance Designation of Alternate Beneficiary | You are automatically the beneficiary if a family member who is covered under your Expanded Dependent Life and/or Accidental Death and Dismemberment (AD&D) insurance plans dies. However, if you want someone else to receive benefits if a covered family member dies, complete this form. (Submit form to UC/HR Benefits address on form.) | UC Davis / UC Davis Health |
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UBEN 132 UC Retirement Plan Service Credit Verification Request | Use this form for service credit adjustments that do not require payment or to correct incomplete or incorrect data that could affect your UCRP benefits (UCRP service credit, UCRP entry date, or your birthdate). (Submit form and records to UCOP address on form.) | UC Davis / UC Davis Health |
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UC Oath of Allegiance & Patent Acknowledgement | All new employees fill out form before first day of work. Submit to: Onboarding Coordinator |
UC Davis / UC Davis Health | ||
UCPath Access/Cognos Report Request Form | Departments use this online form to request employees be provisioned access to Cognos Reports and/or UCPath security roles. Visit the local UCPath Security webpage for instructions on using the form and a list of Security Liaisons. | UC Davis / UC Davis Health | ||
UCRP Reemployment Notification | To be completed by retirees who receive monthly retirement income and are reemployed in a senior management or staff position. Submit to: Onboarding coordinator |
UC Davis / UC Davis Health | ||
UC Procurement Services - Source Selection & Price Reasonableness Justification form |
This document must be completed by the requesting Department for all federally funded purchases ≥$10,000 (including tax and shipping) & non‐federally funded purchases ≥$100,000 (excluding tax, but including shipping), to substantiate the appropriateness of source selection and price reasonableness. | UC Davis / UC Davis Health | ||
UCRS 419 Statement Concerning Your Employment in a University Position Not Covered by Social Security | This form explains how not being subject to Social Security may affect future Social Security benefits to which the individual may become entitled. This form complies with the Social Security Protection Act. (Submit form to UC HR/Benefits address on form.) | UC Davis / UC Davis Health |
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Union Job Steward Grievance-Related Release Time Request | Union designated employee representative fills out form to request paid release time for grievance-related activities. Submit to: Employee's Supervisor |
UC Davis / UC Davis Health |
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UPAY 850 Enrollment, Change, Cancellation or Opt-Out | Use this form to enroll in, change, cancel, or opt out of insurance plans for yourself and/or your eligible family members. (Submit form to Employee Benefits.) | UC Davis / UC Davis Health |
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Verification of Licensure or Certification | Complete this form to verify that an employee has a current license or certificate required for their job. Submit to: UC Davis Health HR Records |
UC Davis Health | ||
Verification of Previous Employment | Complete this form to request verification of previous UC, CSU, or State of CA employment. Submit to: Payroll |
UC Davis | ||
Violation of Non-Smoking Policy Letter Template | This template gives management an idea of how to address an employee who is violating the University's non-smoking policy. | UC Davis Health | ||
Volunteer Information Record | Departments may use this form to collect volunteer's personal information. It also serves as a checklist to determine volunteer eligibility, and document volunteer onboarding activities. Departments should retain this form as Workers' Compensation will request a copy in the event of a volunteer illness/injury. |
UC Davis / UC Davis Health | ||
W4 - Employee's Withholding Allowance Certificate | Used by employers to determine the correct amount of tax withholding to deduct from employees' wages. Submit to: Payroll |
UC Davis / UC Davis Health | ||
Waiver of Recruitment | Form used by departments when applying for a waiver of recruitment as outlined in PPSM-20. | UC Davis/UC Davis Health | ||
Worker’s Compensation Claim Form (DWC 1) & Notice of Potential Eligibility | Complete this form to file a workers’ compensation claim with your employer. Submit to: Workers' Compensation, Fax: 916-734-2484 |
UC Davis Health | ||
UC Davis Workers' Compensation | For the Davis campus: The link at the left leads to Safety Services, where you will find Workers' Compensation forms, information and assistance. | UC Davis | ||
Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility | For the Health campus: Complete this form to file a workers’ compensation claim with your employer. Submit to: Workers' Compensation, Fax: 916-734-2484 |
UC Davis Health | ||
Workers' Compensation Departmental Injury/Illness Worksheet | For the Health campus: Complete this form to file a workers’ compensation claim with your employer. Submit to: Workers' Compensation, Fax: 916-734-2484 |
UC Davis Health |