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

 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.
 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) for Clerical (CX) Unit (PDF)  This form is for Clerical employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Health Care Professionals (HX) Unit (PDF)  This form is for Health Care Professionals employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Personnel Policies for Staff Members (PPSM) Employees (PDF) This form is for PPSM employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Registered Nurse (NX) and Patient Care Technical (EX) Units (PDF)  This form is for Registered Nurses and Patient Care Technical employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Research Support Professionals (RX) Unit (PDF)  This form is for Research Support Professionals employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Service (SX) Unit (PDF)  This form is for Service employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for State Employees Trades Council (SETC) Unit (PDF)  This form is for State Employees Trades Council employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Compensatory Time Off (CTO) for Technical (TX) Unit (PDF)  This form is for Technical employees to elect whether they wish to be compensated for overtime hours by pay or CTO.
 Contract - Amendment/Extension Form (DOC) To initiate a change to an existing employment contract, complete the "Amendment/Extension" form.
 Contract - MSP Form (DOC) Use this form as an employment contract for a position classified as Management & Senior Professional (MSP).
 Contract - PSS Exempt Form (DOC) This is an employment contract for a position classified as Professional Staff Program (PSS)-Exempt.
 Contract - PSS Non-Exempt Form (DOC) This is an employment contract for a position classified as Professional Staff Program (PSS)-Non-Exempt.
 Demographic Data Transmittal Form (PDF)  New employees hired on or after August 1, 2010, must complete the new Demographic Data Transmittal Form (Form U5605). 

 Discrimination/Harassment/Retaliation Complaint Form (DOC)
 Discrimination/Harassment/Retaliation Complaint Form (PDF)  

Use this form to begin the complaint investigation process.
 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.
 Employment Agreement Contract Addendum (DOC)  This form includes language developed by the Office of General Counsel regarding the applicability of the salary reduction/furlough plan to newly negotiated contract appointments. 
 Employee-initiated Reduction in Time (ERIT) Program Contract  ERIT participants must complete the ERIT contract to start benefiting from the program.
 FMLA Certification Forms (PDF)  Use these forms when requesting a FMLA leave.
 Leave Of Absence Notice (DOC) This notice must be completed and sent to the Central Benefits Office whenever
an employee goes on leave of absence without pay.
 Performance Evaluation (DOC) This form is designed to evaluate the performance of employees in a broad range of job classifications.
 Professional Development Program Application (DOC)
 Supervisor's Assessment Form (DOC) 
This application packet contains a brief program description, application and supervisor's assessment form.
 Reduced Fee Enrollment Application (PDF)  Upon acceptance as a student, an employee completes this form, along with department signature.
 Request for Order of Layoff Form (DOC) - Represented 
 Request for Order of Layoff Form (DOC) - Policy-Covered 
Departmental administrators complete this form before notifying affected employees of any department layoff proposal or reduction in time actions.
 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.
 Requisition Acknowledgement Packet This packet is intended for the hiring department and consists of multiple forms and fact sheets to assist in the employment process.
 Retired Employee Approvals Form (DOC) 
 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.
 Service Award Request Form (DOC) Use this form when submitting requests for verification of an employee’s service credit.
 Severance Election Form for American Federation of State, County and Municipal Employees (AFSCME) (DOC) This form should be attached to the notice of layoff for employees covered by American Federation of State, County and Municipal Employees (AFSCME).
 Severance Election Form for Personnel Policies for Staff Members (DOC) This form should be attached to the notice of layoff for employees covered by Personnel Policies for Staff Members (PPSM).
 Severance Election Form for University Professional and Technical Employees (UPTE), Health Care Professionals (HX) Unit (PDF) This form should be attached to the notice of layoff for employees covered by University Professional and Technical Employees (UPTE), Health Care Professionals (HX) Unit.
 Severance Election Form for University Professional and Technical Employees (UPTE), Research Support Professionals (RX) Unit (PDF) This form should be attached to the notice of layoff for employees covered by University Professional and Technical Employees (UPTE), Research Support Professionals (RX) Unit.
 Severance Election Form for AFSCME Service (SX) Unit (DOC)  This form should be attached to the notice of layoff for employees covered by AFSCME Service Employees (SX) Unit.
 Severance Election Form for University Professional and Technical Employees (UPTE), Technical (TX) Unit (PDF) This form should be attached to the notice of layoff for employees covered by University Professional and Technical Employees (UPTE), Technical (TX) Unit.
 Severance Election Form for Coalition of University Employees (CUE) (DOC) This form should be attached to the notice of layoff for employees covered by Coalition of University Employees (CUE).
 Sexual Harassment Policy Form (English) (PDF) This form should be signed by UCLA employees to acknowledge they understand the UC Sexual Harassment Policy.
 Sexual Harassment Policy Form (Spanish) (PDF) This form should be signed by UCLA employees to acknowledge they understand the UC Sexual Harassment Policy.
 STAR Award Form 2012-13 (DOC)   
   STAR Award Form 2012-13 (PDF) 
Use this form to nominate an employee for a Staff Appreciation and Recognition Award.
 Temporary Vacation Accrual Exception Request Form (DOC)  Use this form to request a temporary exception from vacation accrual.
 Training Class Enrollment Application Apply for Training and Development Program classes by completing this form.
 UC Benefits Forms and Materials Benefit Representatives should go to this site if they wish to restock their supplies of Benefit Forms and Materials.
 UCLA Billing Statement for Reimbursement (DOC) Use to obtain reimbursement from AFSCME for any AFSCME represented employee who has been on an approved Leave of Absence for union business.
 UCLA Extension Reduced Fee Enrollment and Departmental Recharge Application (PDF) 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.

 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.