Forms

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Forms

Title Short Description Topic Campus
Access Violation Report

Department fills out form when employee organizations commit unauthorized or illegal actions.
Submit to: ELR Department

Employee and Labor Relations UC Davis Download
All UC Davis Campus Payroll forms

Accounting & Financial Services website.

Payroll UC Davis Link
Background Check Authorization

Certain positions at UC Davis Health require a successful background check as a condition of employment.
Submit to: Shared Services Organization, Recruitment coordinators

Recruitment UC Davis Health Download
Background Check Authorization to Release Information (Live Scan)

Certain positions at UC Davis and UC Davis Health require a successful background check as a condition of employment/assignment.

Recruitment UC Davis and UC Davis Health Download
Background Check Worksheet

For department heads to list reasons for background check. Submit to: Hiring Manager

Recruitment UC Davis and UC Davis Health Download
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 

All UC Davis Health Download
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

Leave/Time-Off UC Davis and UC Davis Health Download
Catastrophic Leave - Employee Request for Catastrophic Leave

Form through which employees who have exhausted their personal leave options can request leave donations from colleagues or the University pool for Catastrophic Leave.
Submit to: Supervisor/Manager or Department Human Resources

Employee and Labor Relations UC Davis and UC Davis Health Download
Catastrophic Leave - Request for Donations (Exhibit B)

Email template for departments to use to notify employees of a colleague’s request for Catastrophic Leave donations.
Submit to: Department employees

Leave/Time-Off UC Davis and UC Davis Health Download
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

Onboarding UC Davis and UC Davis Health Download
Classification Review 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/

Compensation UC Davis Health Download
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. 

All UC Davis and UC Davis Health Link
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.

Employee and Labor Relations UC Davis Download
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.

Employee and Labor Relations UC Davis Download
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.

Employee and Labor Relations UC Davis Download
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.

Employee and Labor Relations UC Davis Download
Compensatory Time Notification Form (K3 Unit) (Davis Campus Only)

Allows employees in the Skilled Trades Unit (K3) 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.

Employee and Labor Relations UC Davis Download
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. 

Employee and Labor Relations UC Davis Download
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. 

Employee and Labor Relations UC Davis Download
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. 

Employee and Labor Relations UC Davis Download
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.

Employee and Labor Relations UC Davis Download
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

All UC Davis Health Download
Demographic Data

Complete this form to provide demographic information for employment.
Submit to: Shared Services Organization, Recruitment coordinators

Recruitment UC Davis Health Download
Direct Deposit Election

Allows new and rehires to provide banking information for e-direct deposits.
Note: Found under Employee Self-Service Dropdown.

Payroll UC Davis and UC Davis Health Link
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

Onboarding UC Davis and UC Davis Health Download
Employee Separation

Complete this form when an employee is separating.
Submit to: Shared Services Organization, UC Davis Health Records Unit

Records UC Davis Health Download
Employee Time Record

Employees can fill out this form to record hours worked prior to online TES/Ecotime account activation.
Submit to: Payroll

Onboarding UC Davis and UC Davis Health Download
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.

All UC Davis and UC Davis Health Download
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

Onboarding UC Davis and UC Davis Health Download
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/

Compensation UC Davis Health Download
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

Leave/Time-Off UC Davis Download
Flexible Work Agreement/Remote Work Agreement (UC Davis Health)

Use the Flexible Work Agreement form when employees will work 100% onsite but have a flexible schedule.

Use the Remote Work Agreement form when employees will work remotely. Please refer to the Digital Workplace Program website for more information on remote work arrangements.

All UC Davis Health
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.

All UC Davis Link
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

Leave/Time-Off UC Davis and UC Davis Health Download
FMLA Certification for Leave Arising out of Active Duty

For employees requesting FML for a covered military member being called to active duty.
Submit completed form to: Leave Team

Leave/Time-Off UC Davis and UC Davis Health Download
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 completed form to: Leave Team

Leave/Time-Off UC Davis and UC Davis Health Download
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 completed form to: Leave Team

Leave/Time-Off UC Davis and UC Davis Health Download
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 completed form to: Leave Team

Leave/Time-Off UC Davis Download
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 completed form to: Leave Team

Leave/Time-Off UC Davis and UC Davis Health Download
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. 

Leave/Time-Off UC Davis Download