Select the appropriate form for use. To get more information regarding a particular form, click on the title name of that form for details.
| Form, NOTICE, TEMPLATE | Details | |
|---|---|---|
| Affirmative Action Quarterly Training Record for Career Staff/Form E (DOC) | Assists departments in meeting their affirmative action record keeping requirements related to selection for training or apprenticeship programs. | |
| Information on minimum wage for all California industries. | ||
| Catastrophic Leave Program Recipient Application Request Form (DOC) Catastrophic Leave Program Donor Form (DOC) | Use the appropriate form to apply as a recipient or a donor for the Catastrophic Leave Program. | |
| COBRA Continuation of Group Coverage (PDF) | Use this form to supplement the COBRA IDOC, UBEN 102 or UBEN 108. | |
| Compensatory Time Off (CTO) Election Form (DOC) | This form is for policy-covered employees and employees in bargaining units that allow the option of compensatory time off (“comp time”) to elect comp time in lieu of overtime pay. | |
| Contract - Employment Agreement Amendment/Extension Template - SAMPLE | Use this sample template as a reference when creating an amendment to an existing employment contract. | |
| Contract - MSP (Exempt) Employment Agreement Template - SAMPLE | Use this sample template as a reference when creating a contract for a position classified as Management & Senior Professional (MSP). | |
| Contract - MSP (Non-Exempt) Employment Agreement Template - SAMPLE | Use this sample template as a reference when creating a contract for a position classified as Management & Senior Professional (MSP). | |
| Contract - PSS (Exempt) Employment Agreement Template - SAMPLE | Use this sample template as a reference when creating a contract for a position classified as Professional and Support Staff (PSS) - Exempt. | |
| Contract - PSS (Non-Exempt) Employment Agreement Template - SAMPLE | Use this sample template as a reference when creating a contract for a position classified as Professional and Support Staff (PSS) - Non-Exempt. | |
| Contract - Request for Exception Form | Use this form to request an extension of an employment contract | |
| Demographic Data Transmittal Form (PDF) | New employees hired on or after August 1, 2010, must complete the new Demographic Data Transmittal Form (Form U5605). | |
| Dual-Employment Form (DOC) | For staff appointments only, use this form for requesting dual employment at UCLA. | |
| Emergency Vacation Leave Sharing Program - Donor Form (DOC) Emergency Vacation Leave Sharing Program - Recipeint Application Form (DOC) | Use these forms for the Emergency Vacation Leave Sharing Program, an emergency program for temporary implementation in response to natural disasters. (Contact CHR before use.) | |
| Employee Development Fee Reimbursement Form (DOC) | This form is only for programs that are not required by the department head but are approved for employee development. | |
| Employee-initiated Reduction in Time (ERIT) Program Contract | ERIT participants must complete the ERIT contract to start benefiting from the program. | |
| Employee Religious Accommodation Request Form for Flu Vaccine Mandate | Use this form when employee's request an exemption from the mandated Flu Vaccine. | |
| Family & Medical Leave Act (FMLA) - Employee Rights (English) Family & Medical Leave Act (FMLA) - Employee Rights (Spanish) | Information on FMLA leave and your rights as an employee. | |
| FMLA Certification Forms FMLA Return to Work Form | Use these forms when requesting a FMLA leave. | |
| Family Care & Medical Leave (CFRA) and Pregnancy Disability Leave (PDL) (English) Family Care & Medical Leave (CFRA) and Pregnancy Disability Leave (PDL) (Spanish) | Information on CFRA and PDL that will help you navigate these important employee leaves. | |
| FlexWork Agreement | This agreement must be completed for all staff employees working on a remote (or hybrid) basis, and/or working an alternate work schedule. | |
| Layoff Request Form | Use this form when requesting a layoff for an employee | |
| Leave Of Absence Notice | This notice must be completed and sent to the Central Benefits Office whenever an employee goes on leave of absence without pay. | |
| Multi-Location Appointment/Interlocation One-Time Payment Form | All the information you need is included in this form, including instructions on how to fill it out. | |
| Near Relative Policy Exception Request | Use this form to request an exception to the Near Relative Policy | |
| New Hire or Recruitment Authorization Form | Use this form for new hires or recruitments during the COVID-19 crisis. | |
| Performance Evaluation Form | This form is designed to evaluate the performance of employees in a broad range of job classifications. | |
| Pregnancy Disability Leave (PDL) - Employee Rights & Obligations (English) Pregnancy Disability Leave (PDL) - Employee Rights & Obligations (Spanish) | Important information on PDL and employee rights. | |
| Professional Development Program Application Supervisor's Assessment Form | This application packet contains a brief program description, application and supervisor's assessment form. | |
| Proof of Service Form | Complete this form when needing proof of service for a delivery or mail. | |
| Reference Checking - Sample Reference Check Form | Use this form when documenting telephone reference checks for staff employment. | |
| Request for Verification of Previous Employment (DOC) | This form should be used for verification of previous University of California, California State University or State of California Employment Service credit. | |
| Retired Employee Approvals Form UC Rehired Retirees Policy, Implementation Procedures & UCLA Local Procedures | The hiring manager must complete this form for retired employees reemployed into staff positions. This form must be sent in with the UCRP Waiver Election Form. | |
| Severance Calculator | Helpful worksheet for calculating severance for non-exempt and exempt employees | |
| Use this form to indicate election of severance pay or recall and preference for reemployment | ||
| Staff Diversity & EEO Compliance Office Complaint Form (PDF) Staff Diversity & EEO Compliance Office Complaint Form (DOC) | Use this form to start the Complaint Process | |
| STAR Award Form FY 24-25 | Use this form to nominate an eligible employee for a STAR Award | |
| Temporary Layoff Request Form | Use this form for submitting a request for a temporary layoff | |
| UC Benefits Forms and Materials | Benefit Representatives should go to this site if they wish to restock their supplies of Benefit Forms and Materials. | |
UC Benefits Information for Employees Being Laid Off (English) UC Benefits Information for Employees Being Laid Off (Spanish) | Guide Sheet for employees who have been laid off. | |
| UC Location Data Request Form | UCOP form for documenting data on staff recruitments assisted by executive search firms. | |
| UC Mandatory Employment Notices/Posters | Get all the mandatory notices and posters in one convenient place. | |
UCLA Billing Statement for Reimbursement for EX and SX (DOC)
| Use to obtain reimbursement from AFSCME for any EX or SX represented employee who has been on an approved Leave of Absence for union business. Use to obtain reimbursement from Teamsters for any CX or K4 represented employee who has been on an approved Leave of Absence for union business.
| |
| UCLA Extension Reduced Fee Enrollment and Departmental Recharge Application | Packet contains information about UCLA Extension and the special Reduced Fee Enrollment and Departmental Recharge Application. | |
| UCLA Procedures for Reimbursement for Leaves for Union Business (DOC) | Document describes the procedure to be followed to obtain reimbursement on approved Leave of Absence for union business. | |
| UCLA Reduced Fee Enrollment Application (DOC) | Complete this document to apply for a reduction in course fees. | |
| UCRP Waiver for Rehired Retirees Factsheet (PDF) UCRP Reemployed Retiree Notfication Form (PDF) | Factsheet and waiver form for rehired UCRP retirees returning to UC employment. | |
| Vacation Accrual Maximum Exception Request Form (PDF) Vacation Accrual Maximum Exception Request Form (DOC) | Use this form when requesting an exception to the Maximum Vacation Accrual Policy. |
