INFORMATION & FORMS
Alphabetical Listing by TitleListing by PER Form #
FORM#FORM NAME
ADVANCE STEP REQUEST FORM
BENEFITS ENROLLMENT FORMS
DMV PULL NOTICE (DOCUSIGN)
DPO SDI INTEGRATION FORM
SEIU SDI INTEGRATION FORM
CalHR-062PARTIAL SERVICE RETIREMENT APPLICATION
CALPERS-1007CalPERS NOTICE OF EXCLUSION (for Extra Help)
CALPERS-1187CalPERS RECIPROCAL SELF-CERTIFICATION PACKET
DE-4 STATE EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE
LAC LACTATION INFORMATION
LCORIGHTS OF VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT AND STALKING
PER59BILINGUAL PROGRAM FORM
PER65AFPOSITION DESCRIPTION FORM - SHORT FORM
PER65BFPOSITION DESCRIPTION FORM - LONG FORM
PER66POSITION DESCRIPTION FORM SUPPLEMENT FOR SUPERVISORY POSITIONS
PER119A AB 119 INFORMATION COLLECTION FORM
PER119B AB119 OPT-OUT FORM
PER169JUSTIFICATION TO HIRE A RETIRED ANNUITANT
PER191EEO REGULATIONS
PER1019AIN-PROCESSING CHECKLIST - REGULAR
PER1019BIN-PROCESSING CHECKLIST - EXTRA HELP
PER1020AWELCOME LETTER REGULAR (NO PHYSICAL)
PER1020BWELCOME LETTER REGULAR (PHYSICAL)
PER1020CWELCOME LETTER EXTRA HELP (NO PHYSICAL)
PER1020DWELCOME LETTER EXTRA HELP (PHYSICAL)
PER1020EPERSONNEL LIAISON WELCOME PACKET CHECKLIST FOR REGULAR APPOINTMENTS
PER1020FPERSONNEL LIAISON WELCOME PACKET CHECKLIST FOR EXTRA HELP APPOINTMENTS
PER1021AEMPLOYEE CHECKLIST FOR IN PROCESSING (NO PHYSICAL)
PER1021BEMPLOYEE CHECKLIST FOR IN PROCESSING (PHYSICAL)
PER1021CEMPLOYEE CHECKLIST FOR IN PROCESSING - EXTRA HELP (NO PHYSICAL)
PER1021DEMPLOYEE CHECKLIST FOR IN PROCESSING - EXTRA HELP (PHYSICAL)
PER1021EEMPLOYEE CHECKLIST FOR BENEFITS ONLY IN PROCESSING
PER1022DOCUMENTS FOR EMPLOYMENT ELIGIBILITY - I-9 INFORMATION
PER1025HEALTH QUESTIONNAIRE
PER1025APARENTAL RELEASE FORM (UNDER 18 YEARS OF AGE)
PER1025BPRE-EMPLOYMENT HEALTH QUESTIONNAIRE
PER1025CMAP TO AGILE OCCMED
PER1025DMAP 2 TO CAPITOLA PHYSICAL THERAPY
PER1026DEFERRED COMP WELCOME LETTER
PER1030V BENEFITS SUMMARY - ALL EMPLOYEES
PER1040NEW EMPLOYEE STATUS & INFO SUMMARY
PER1041ASALARY/COMP/LEAVE - GENERAL REP UNIT
PER1041BSALARY COMP LEAVE - LE & SGTS UNITS
PER1041CSALARY/COMP/LEAVE - MID MGT UNIT
PER1041DSALARY/COMP/LEAVE - LEMM UNIT
PER1041ESALARY/COMP/LEAVE - MGT TRAINEES
PER1041FSALARY/COMP/LEAVE - OTHER EXECUTIVE MGT
PER1041GSALARY/COMP/LEAVE - APPTED DEPT HEAD/ASST
PER1041HSALARY/COMP/LEAVE - BOARD & ELECTED DH
PER1041ISALARY/COMP/LEAVE - CORRECTION OFF
PER1041JSALARY/COMP/LEAVE - DA INSPECTOR UNIT
PER1041KSALARY/COMP/LEAVE - PHYSICIANS' REPRESENTATION UNIT
PER1041LSALARY/COMP/LEAVE - DEPUTY PROBATION OFFICER UNIT
PER1041MSALARY/COMP/LEAVE - GOVERNMENT ATTORNEYS UNIT
PER1042ACalPERS RETIREMENT CHECK LIST-MISCELLANEOUS
PER1042BCalPERS RETIREMENT CHECK LIST-SAFETY-COUNTY PEACE OFFICER
PER1042CCalPERS RETIREMENT CHECK LIST-SAFETY-SHERIFF
PER1043EXTRA HELP CalPERS RETIREMENT CHECKLIST
PER1045 AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION
PER1046 WORKER'S COMP TIME OF HIRE NOTICE
PER1053BOARD OF SUPERVISOR'S POLICY: FLSA
PER1054EXTRA HELP EMPLOYMENT - GENERAL REP UNIT
PER1054BEXTRA HELP EMPLOYMENT - UNREPRESENTED
PER1056FMLA NOTICE - GENERAL UNIT
PER1057FMLA NOTICE - LAW ENFORCEMENT UNIT
PER1058FMLA NOTICE - MIDDLE MGT UNIT
PER1059FMLA NOTICE - LAW ENF MID MGT UNIT
PER1060 FMLA NOTICE - CORRECTIONAL OFFICER UNIT
PER1061FMLA NOTICE - GOVERNMENT ATTORNEYS ASSOCIATION & EXEC MGT
PER1063NOTIFICATION OF POLICIES
PER1073REQUEST FOR MILITARY LEAVE-ACTIVE DUTY
PER1081APHYSICIAN'S CERT - LEAVE OF ABSENCE-EMPLOYEE
PER1081BPHYSICIAN'S CERT - FMLA
PER1082A EMPLOYEE REQUEST FOR TIME OFF (.pdf form)
- Request For Time Off Help
EMPLOYEE REQUEST FOR TIME OFF (DocuSign form)
- Request for Time off & DocuSign Getting Started Guide
PER1083EMPLOYEE REQUEST LOA W/OUT PAY
PER1084EMPLOYEE OBLIGATIONS UNDER FMLA
PER1085RESPONSE TO EMPLOYEE REQUEST FOR FMLA LEAVE
PER1086PHYSICIAN'S CERTIFICATION - RETURN FROM LEAVE
PER1088VOLUNTARY REDUCTION OF HOURS FORM
PER1089VOLUNTARY TIME OFF FORM
PER1095DONATION OF ACCRUED PAID LEAVE - TIME BANK
PER1100AREASONABLE ACCOMMODATION REQUEST
PER1142MEDICAL AUTHORIZATION RELEASE FORM
PER1171EMPLOYEE PERFORMANCE EVAL AND DEV REP
PER1200PAYROLL TRANSACTION CODES
PER1201PAYROLL EMPLOYEE STATUS CODES
PER1202BENEFIT STATUS CODES/DEFINITIONS
PER1203PAYROLL/PERSONNEL POSITION NUMBER CODES
PER1205NAME CHANGE FORM
PER1206RETRAINING PAY ADJUSTMENT FORM
PER1207DIFFERENTIAL FORM
PER1208PAYROLL CODES - UNFUNDED & PARTIAL YR
PER1209CHANGE OF ADDRESS/TELEPHONE FORM
PER12109/80 ALTERNATE WORKWEEK SCHEDULE REQUEST
PER1301GRIEVANCE FORM - GENERAL REP UNIT
PER1302GRIEVANCE FORM - LAW ENFORCEMENT UNIT
PER1303GRIEVANCE FORM - MIDDLE MGT UNIT
PER1304GRIEVANCE FORM - LAW ENF MID MGT UNIT
PER1305 GRIEVANCE FORM - SHERIFF'S CORRECTIONAL OFFICER REPRESENTATION UNIT
PER1306GRIEVANCE FORM - GOVERNMENT ATTORNEYS REPRESENTATION UNIT
PER1307GRIEVANCE FORM - PHYSICIAN'S REPRESENTATION UNIT
PER1308GRIEVANCE FORM - GENERAL REPRESENTATION EXTRA HELP UNIT
PER1309GRIEVANCE FORM - DA INSPECTORS REPRESENTATION UNIT
PER1310GRIEVANCE FORM - SHERIFF'S SUPERVISORY REPRESENTATION UNIT
PER1311GRIEVANCE FORM - DEPUTY PROBATION OFFICER UNIT
PER1360TUITION REIMBURSEMENT FORM - GENERAL REP
PER1507BDOT REQUIREMENTS - EMPLOYEE NOTICE
PER1801SALARY STUDY REQUEST
PER1900PARTIAL SERVICE RETIREMENT AGREEMENT
PER3011REFERENCE CHECK - RELEASE/WAIVER FORM
PER3012PERSONNEL RECORDS REVIEW FORM
PER3039NEW POSITION REQUEST/BOS ACTION
PER3061GUIDE TO DEPARTMENTAL SELECTION INTERVIEW
PER3116REQUEST FOR CLASSIFICATION STUDY
PER3124CIVIL SERVICE COMMISSION APPEAL INFORMATION
PER3125CIVIL SERVICE COMMISSION APPEAL FORM
PER3133INTERN AGREEMENT
PER3151REMOVE CANDIDATE FROM LIST REQUEST
PER3161REQUEST PLACE ON EMPLOYMENT TRAINING LIST
PER4002DISCRIMINATION/HARASSMENT COMPLAINT
PER4003ADA FORMAL COMPLAINT INSTRUCTIONS
PER4027EEO/NONDISCRIMINATION & REASONABLE ACCOMODATION POLICY BROCHURE
PER5003CLAIM AGAINST THE COUNTY OF SANTA CRUZ
PER5003SCLAIM AGAINST THE COUNTY OF SANTA CRUZ(Spanish)
PER5004VEHICLE ACCIDENT REPORT
PER5006EMPLOYEE CLAIM - EQUIPMENT LOSS/STOLEN
PER5012INCIDENT REPORT FORM - NON EMPLOYEE
PER5013PROPERTY LOSS REPORT FORM
PER5013DPWPROPERTY LOSS REPORT FORM FOR DEPART OF PUBLIC WORKS
PER5300ASEPARATION PACKET
PER5300BSEPARATION PACKET - EDD
PER6051SAFETY SUGGESTION FORM
PER6056LONGEVITY DIFFERENTIAL AFFIDAVIT
PER6057 LONGEVITY DIFFERENTIAL AFFIDAVIT - EXTRA HELP
PER6058 LONGEVITY DIFFERENTIAL AFFIDAVIT - GENERAL REP UNIT (SEPARATION FOR ANY REASON OTHER THAN EDUCATION)
PER6058A LONGEVITY DIFFERENTIAL AFFIDAVIT - GENERAL REP UNIT (SEPARATION FOR EDUCATIONAL PURPOSES)
PER7000DA INSPECTOR CELLULAR PHONE REIMBURSEMENT FORM
PER7001 GOVT ATTORNEYS CELLULAR PHONE REIMBURSEMENT FORM
VIPVIP - ACCIDENT POLICY
VIPVIP - ACCIDENT FORM
VIPVIP - APPLICATION PACKET
VIPVIP - AUTO INSURANCE
VIPVIP - DEPARTMENT REQUEST
VIPVIP - TIMESHEET
VIPVIP - TIPS FOR COMPLETING A DEPARTMENT REQUEST FORM
W-4 EMPLOYEE'S WITHHOLDING CERTIFICATE