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2016 Monthly Premiums for Health |
Human Resources |
 2016_calpers_health_benefit_premiums_use.pdf |
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2016 Open Enrollment - Health Plan Change Only Form |
Human Resources |
calpers_hbe_form_2016_oe_editable.pdf |
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2016 Open Enrollment Benefits Communication |
Human Resources |
open-enrollment-cummunication_2016.pdf |
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2016 Open Enrollment Notice to Campus |
Human Resources |
oe_for_2016_notice_to_campus.pdf |
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2017 CalPERS Health Benefit Premiums |
Human Resources |
2017_calpers_health_benefit_premiums.pdf |
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Authorization to Transport Form |
Human Resources |
authorization_to_transport_form_2024.pdf |
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Benefits Fair Flyer |
Human Resources |
oe_and_benefit_fair_flyer2.pdf |
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CAL-ORE Life Flight Membership Form |
Human Resources |
cal_ore_application_2024.pdf |
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CalPERS Health Benefit Plan Enrollment Form |
Human Resources |
calpers_hbe_form_2017_oe.pdf |
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CalPERS Health Plan Benefit Comparison |
Human Resources |
calpers_health_plan_benefit_comparison_1_sheet_0.pdf |
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CalPERS Retirement Refund Application Form |
Human Resources |
calpers_refund_election_package.pdf |
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Catastrophic Leave Donation Form - Family Care |
Human Resources |
https://hsu.link/cla-familycare |
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Catastrophic Leave Donation Form - Self |
Human Resources |
https://hsu.link/cla-self |
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CSU 403(b) form |
Human Resources |
csu_403b_srp_enrollment_form_new_number.pdf |
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CSU Employee Benefits Summaries - Academic Student Employees (Unit 11) |
Human Resources |
uaw-unit-11-benefits-summary.pdf |
|
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DCRA-HRCA Enrollment Form |
Human Resources |
dcra-hcra-2018-enrollment-form.pdf |
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Dependent Verification Affidavit |
Human Resources |
dep_verification_affidavit.pdf |
|
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e-Benefits Self-Service Electronic Signature Authorization Form |
Human Resources |
e-benefits_electronic_sig_auth_form.pdf |
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Early Exit Program Application |
Human Resources |
eep_application.pdf |
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STD. 686 |
Employee Action Request - FOR UPDATES (EAR) |
Human Resources |
https://hsu.link/ear_updates |
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Employment History Form |
Human Resources |
employment_history.pdf |
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Executive Order 1083: Attachment C |
Human Resources |
attachment_c_-_limited_reporters_acknowledgment.pdf |
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Executive Order 1083: Attachment D - Child Abuse Reporting Form |
Human Resources |
attachment_d_-_general_reporters_acknowledgment.pdf |
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Executive Order 1083: Attachment E - Suspected Child Abuse Report |
Human Resources |
attachment_e_-_suspected_child_abuse_report.pdf |
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Executive Order 1096 Complaint Form |
Human Resources |
eo-1096_complaint_form_march_29_2019.pdf |
|
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Executive Order 1097: Student Complaint Form |
Human Resources |
eo-1097_complaint_form_march_29_2019.pdf |
|
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Fee Waiver - Fees Waived (Dependent) |
Human Resources |
fees_waived_-_dependent_0.pdf |
|
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Fee Waiver - Fees Waived (Employee) |
Human Resources |
fees_waived_-_employee_0.pdf |
|
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Fee Waiver Application Fee Refund Request |
Human Resources |
fee_waiver_application_fee_refund_request_2024.pdf |
|
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Fee Waiver Application-Dependent |
Human Resources |
https://apex.humboldt.edu/ords/f?p=245:10 |
|
|
Fee Waiver Application-Self |
Human Resources |
https://apex.humboldt.edu/ords/f?p=245:11 |
|
107 |
Form 107: Application for Leave of Absence |
Human Resources |
https://hsu.link/leave_of_absence |
|
700 |
Form 700 - Form Only |
Human Resources |
form_700.pdf |
|
700 |
Form 700 - Full Document |
Human Resources |
form_700_full.pdf |
|
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HCRA/DCRA 2016 Open Enrollment Form |
Human Resources |
drca_hcra_oe_form.pdf |
|
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HSU Background Check Packages |
Human Resources |
hsu_background_check_packages_march2017update.pdf |
|
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New Employee Sign-Up Chain of Custody Agreement |
Human Resources |
newemployeesign-upchainofcustody.pdf |
|
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Paid Sick Leave (SB 95) Request Form |
Human Resources |
spsl_request_form.pdf |
|
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Paperwork Completion Sheets |
Human Resources |
paperwork_completion_sheet.pdf |
|
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Pre-Designation of Physician |
Human Resources |
noticetoemployeespre-des.pdf |
|
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Request for CSU Expanded COVID-19 Related Leave - Everyone Else |
Human Resources |
ecrl_form_-_fillable_and_accessible.pdf |
|
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Request for CSU Expanded Covid-19 Relief Leave - Unit 6 |
Human Resources |
ecrl_request_form_unit_6_final-fillable-accessible.pdf |
|
|
Request for CSU Temporary Paid Leaves (TLP, CPAL, & NTWL) |
Human Resources |
covid-19_temporary_leaves_request_form_-_tlp-cpal-ntwl.pdf |
|
|
Request for CSU Temporary Paid Leaves (TLP, CPAL, & NTWL) |
Human Resources |
covid-19_temporary_leaves_request_form_-_cpal_only.pdf |
|
|
Request for Emergency Paid Sick Leave/Emergency FML Expansion |
Human Resources |
covid-19_leaves_request_form_-_ffcra.pdf |
|
|
Savings Plus Benefits Payment Booklet |
Human Resources |
https://nationwidefinancial.com/media/pdf/NRM-4204CA.pdf?_ga=2.218510169.1738... |
|
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Self Service Guide: My Benefit Enrollments |
Human Resources |
self-service_guide.pdf |
|
|
Summer Bridge - Employee Action Request |
Human Resources |
ear_summer_bridge.pdf |
|
|
Summer Bridge - Employee Information Form |
Human Resources |
summer_bridge_employee_information_form_17_v2.pdf |
|
|
Summer Bridge - Header Form |
Human Resources |
summer_bridge-_header_form.pdf |
|
|
Summer Bridge - Time Voucher, July |
Human Resources |
july_bridge_2020.pdf |
|
|
Summer Bridge - Time Voucher, June |
Human Resources |
june_bridge_2020.pdf |
|
|
Summer Bridge Student Assistant Appointment Form |
Human Resources |
 bridge_appointment_form_2020.xls |
|
|
Supervisor's Report of Injury |
Human Resources |
supervisors_report.pdf |
|
|
TSA Information |
Human Resources |
saving_made_easy_brochure_2016_final.pdf |
|
|
VSP Premiere Enrollment Form |
Human Resources |
https://hsu.link/vsp-premiere-enrollment |
|
|
W-2 (replacement request) |
Human Resources |
http://www.sco.ca.gov/ppsd_empinfo_dpw-2.html |
|
|
Workers' Comp Quick Guide |
Human Resources |
wcprocessforsupvrev04-15.pdf |