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Form

   

Description

Campus

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.
Submit to: hs-careerladder@ou.ad3.ucdavis.edu 

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.
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. 

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. 
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.
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. 

UC Davis 

Compensatory Time Notification Form (HX Units)

(Davis Campus Only) 

 

   

Allows employees in the Health Care Professionals Unit (HX) 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. 

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. 
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.
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. 

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.
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. 

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.
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. 

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     Complete to request an equity increase. 
Submit to: Compensation/Classification
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

Flex/Remote Work Agreement

(UC Davis Health)

   
Learn about the various flexible work options and use the proposal form to request a flexible work schedule.
Please refer to the Digital Workplace Program website for more information and current forms.
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 reasonableaccommodationrequest@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.
Submit to: TAP submits completed form to the Manager, Leadership Recruitment & Diversity Services (LR&DS) and Talent Acquisition Manager.

UC Davis / UC Davis Health
Interview Rating Scale for Managers & Supervisors     For Hiring Departments to use during the interview process. 
Submit to: For supervisor use only
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
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
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
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      Managers and supervisors use this form to document permanent accommodations.
Submit to: Disability Management Services
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     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 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
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
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 reasonableaccommodationrequest@ucdavis.edu  
Stipend Request     Complete to request a stipend. 
Submit to: Compensation/Classification
UC Davis Health
Supplement to Military Pay    

Active duty military personnel can receive supplemental compensation.
Submit to: UC Davis - If leave is managed by a Shared Services team, please send to the appropriate office otherwise, please provide to your supervisor.
UC Davis Health - submit to: hs-hrrecords@ucdavis.edu

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    

Managers and supervisors use this form to document temporary accommodations.
Submit to: Disability Management Services

*Please note that we are currently experience technical difficulties with the webform and are actively working on a system solution. Until further notice please use the fillable PDF form instead.

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
UAW Local 2865 Membership Election Form     New ASE employees fill out this form if they want to join the UAW union.
Submit to: ELR Department
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
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
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
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
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
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
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
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
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