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Human Resources Department
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Recognition Employee Recognition Programs President's Outstanding Employee Award President's Special Achievement Award Divisional Distinguished Service Award President's Team Achievement Probationary Award Service Award Luncheon President's Retirement Award
Performance Performance Management Page MPP Confidential Represented Employees Temporary Employees
Employee Relations Employee Relations Page Bargaining Agreements Confidentiality of Personal Information Conflict of Interest CSU Systemwide Policies CSUSB Policies Drug Free Workplace Health & Safety Internet Use Smoking Policy Whistleblower
Leave Programs Leaves Programs Page Sick Leave Catastrophic Leave Family & Medical Bereavement / Funeral Maternity / Paternity / Adoption Pregnancy Leave Non-Industrial Disability (NDI) Long-Term Disability (LTD) Industrial Disability (IDL) Organ Donor Leave Leave Without Pay Other Leaves
HR Processes Hiring Process International Travel Separating from CSUSB Volunteer Process
HR Forms HR Forms Main Page Benefits Compensation Employment Performance Management Recruitment Reclassification Security Training & Development Workers' Compensation Other Forms
PeopleSoft Access Application (CIA Form) Confidentiality & Compliance Form CMS Website Log in to MyCoyote

Human Resources Forms

Benefits Forms

Form Name Adobe Acrobat MS Excel MS Word
Dental Claim Form The Dental Claim form as an Acrobat document    
Benefits New Enrollment Form     Benefits New Enrollment Form as an MS Word document
Benefits Open Enrollment Form     Benefits Open Enrollment Form as an MS Word document
Benefits Changes Form     Benefits Change Form as an MS Word document
HCRA-DCRA Enrollment Form HCRA-DCRA Enrollment Form as an Acrobat document    
HCRA-DCRA Claim Form     HCRA-DCRA Claim Form as an MS Word document
Long Term Care Application Long Term Care Application as an Acrobat document    
Salary Reduction Agreement Salary Reduction Agreement as an Acrobat document    
SPP Enrollment Form SPP Enrollment Form as an Acrobat document    
TSA CatchUp Worksheet   Temporary Evaluation Form as a MS Excel Spreadsheet    
TSA Cert. of Establishment TSA Certification of Establishment as an Acrobat document    
Vision VDT Form Vision VDT Form as an Acrobat document    
Vision Out-of-Network Form Vision Out-of-Network Form as an Acrobat document    

Compensation Forms

Form Name Adobe Acrobat MS Excel MS Word
In-Range Progression     In-Range Progression Form as a MS Word document

Employment Forms

Form Name Adobe Acrobat MS Excel MS Word
CSUSB Application CSUSB Employment Application as an Acrobat document   CSUSB Employment Application as a MS Word document
Foundation Application Foundation Employment Application as an Acrobat document    
Student Union Application Student Union Employment Application as an Acrobat document    
ASI Application     ASI Employment Application as an Acrobat document

Performance Forms

Form Name Adobe Acrobat MS Excel MS Word
Annual Evaluation Form Annual Evaluation Form as an Acrobat document   Annual Evaluation Form as a MS Word document
MPP Evaluation Form MPP Evaluation Form as an Acrobat document   MPP Evaluation Form as a MS Word document
Temp Evaluation Form   Temporary Evaluation Form as a MS Excel Spreadsheet  
Unit 4 Evaluation     Unit 4 Evaluation Form as a MS Word document
3-Month Probationary   3 Month Probationary Form as a MS Excel Spreadsheet  
6-Month Probationary   6 Month Probationary Form as a MS Excel Spreadsheet  
9-Month Probationary   9 Month Probationary Form as a MS Excel Spreadsheet  
11-Month Probationary   11 Month Probationary Form as a MS Excel Spreadsheet  
12-Month Probationary   12 Month Probationary Form as a MS Excel Spreadsheet  
18-Month Probationary   18 Month Probationary Form as a MS Excel Spreadsheet  

Recruitment Forms

Form Name Adobe Acrobat MS Excel MS Word
Hiring Freeze Exemption Form     Hiring Freeze Exemption Form as a Word document
Job Description     Job Description Form as a MS Word document
Search Committee Access Request     Search Committee Access Request Form as a MS Word document
Search Committee Member BPG     Search Committee Member BPG Form as a MS Word document
Staff / MPP Requisition   Staff & MPP Requistion Form as a MS Excel Spreadsheet  

Reclassification Forms

Form Name Adobe Acrobat MS Excel MS Word
Reclassification Request Reclassification Request as an Acrobat document   Reclassification Request as a MS Word document
Reclass Part A Reclassification Part A form as an Acrobat document   Reclassification Part A form as an MS Word document
Reclass Part B Reclassification Part B form as an Acrobat document   Reclassification Part B form as an MS Word document
Position Description Position Description as an Acrobat document   Position Description as a MS Word document
Supervisory Questionnaire Supervisory Questionaire as an Acrobat document   Supervisory Questionaire as a MS Word document

Security Forms

Form Name Adobe Acrobat MS Excel MS Word
CIAR (Access Request) CIAR (Access Request) Form as an Acrobat document    
Confidentiality & Compliance (staff) Confidentiality & Compliance (staff) as an Acrobat document    
R04 Confidentiality & Compliance R04 Confidentiality & Compliance as an Arcobat document    

Training & Development Forms

Form Name Adobe Acrobat MS Excel MS Word
Career Development Plan Career Development Plan as an Acrobat document    
Out-Service Training Funds     Out-Service Training Funds form as a MS Word document

Workers' Compensation Forms

Form Name Adobe Acrobat MS Excel MS Word
WC Claim Form Workers' Compensation Claim Form as an Acrobat document    
Supervisor's Injury Report Supervisor's Injury Report as an Acrobat document    

Other Forms

Form Name Adobe Acrobat MS Excel MS Word
International Travel Request     International Travel Request form as a MS Word document
Volunteer Form Volunteer Form as an Acrobat document    

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Human Resources Department
Sierra Hall, Room 110
Office Hours: Monday - Friday, 8:00 a.m. - 5:00 p.m.
5500 University Parkway, San Bernardino, CA 92407
Voice: (909) 537-5138 | Fax: (909) 537-7019 | Job Hotline: (909) 537-5139 | TDD: (909) 537-7444

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