INFORMATION & FORMS
Alphabetical Listing by Title Listing by PER Form #
FORM NAME	FORM#
9/80 ALTERNATE WORKWEEK SCHEDULE REQUEST	PER1210
AB 119 INFORMATION COLLECTION FORM	PER119A
AB119 OPT-OUT FORM	PER119B
ADA FORMAL COMPLAINT INSTRUCTIONS	PER4003
ADVANCE STEP REQUEST FORM
AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION	PER1045
BENEFITS ENROLLMENT FORMS
BENEFIT STATUS CODES/DEFINITIONS	PER1202
BENEFITS SUMMARY - ALL EMPLOYEES	PER1030V
BILINGUAL PROGRAM FORM	PER59
BOARD OF SUPERVISOR'S POLICY: FLSA	PER1053
CalPERS NOTICE OF EXCLUSION (for Extra Help)	CALPERS-1007
CalPERS RECIPROCAL SELF-CERTIFICATION PACKET	CALPERS-1187
CalPERS RETIREMENT CHECK LIST-MISCELLANEOUS	PER1042A
CalPERS RETIREMENT CHECK LIST-SAFETY-COUNTY PEACE OFFICER	PER1042B
CalPERS RETIREMENT CHECK LIST-SAFETY-SHERIFF	PER1042C
CHANGE OF ADDRESS/TELEPHONE FORM	PER1209
CIVIL SERVICE COMMISSION APPEAL FORM	PER3125
CIVIL SERVICE COMMISSION APPEAL INFORMATION	PER3124
CLAIM AGAINST THE COUNTY OF SANTA CRUZ	PER5003
CLAIM AGAINST THE COUNTY OF SANTA CRUZ (Spanish)	PER5003S
DA INSPECTOR CELLULAR PHONE REIMBURSEMENT FORM	PER7000
EXTRA HELP CalPERS RETIREMENT CHECKLIST	PER1043
GOVT ATTORNEYS CELLULAR PHONE REIMBURSEMENT FORM	PER7001
DEFERRED COMP WELCOME LETTER	PER1026
DIFFERENTIAL FORM	PER1207
DISCRIMINATION/HARASSMENT COMPLAINT	PER4002
DMV PULL NOTICE (DOCUSIGN)
DOCUMENTS FOR EMPLOYMENT ELIGIBILITY - I-9 INFORMATION	PER1022
DONATION OF ACCRUED PAID LEAVE - TIME BANK	PER1095
DOT REQUIREMENTS - EMPLOYEE NOTICE	PER1507B
DPO SDI INTEGRATION FORM
EEO REGULATIONS	PER191
EEO/NONDISCRIMINATION & REASONABLE ACCOMODATION POLICY BROCHURE	PER4027
EMPLOYEE CHECKLIST FOR BENEFITS ONLY IN PROCESSING	PER1021E
EMPLOYEE CHECKLIST FOR IN PROCESSING (NO PHYSICAL)	PER1021A
EMPLOYEE CHECKLIST FOR IN PROCESSING (PHYSICAL)	PER1021B
EMPLOYEE CHECKLIST FOR IN PROCESSING - EXTRA HELP (NO PHYSICAL)	PER1021C
EMPLOYEE CHECKLIST FOR IN PROCESSING - EXTRA HELP (PHYSICAL)	PER1021D
EMPLOYEE CLAIM - EQUIPMENT LOSS/STOLEN	PER5006
EMPLOYEE OBLIGATIONS UNDER FMLA	PER1084
EMPLOYEE PERFORMANCE EVAL AND DEV REP	PER1171
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	PER1082A
EMPLOYEE REQUEST LOA W/OUT PAY	PER1083
EMPLOYEE'S WITHHOLDING CERTIFICATE	W-4
EXTRA HELP EMPLOYMENT - GENERAL REP UNIT	PER1054
EXTRA HELP EMPLOYMENT - UNREPRESENTED	PER1054B
FMLA NOTICE - GOVERNMENT ATTORNEYS ASSOCIATION & EXEC MGT	PER1061
FMLA NOTICE - DETENTION OFFICER UNIT	PER1060
FMLA NOTICE - GENERAL UNIT	PER1056
FMLA NOTICE - LAW ENF MID MGT UNIT	PER1059
FMLA NOTICE - LAW ENFORCEMENT UNIT	PER1057
FMLA NOTICE - MIDDLE MGT UNIT	PER1058
GRIEVANCE FORM - DA INSPECTORS REPRESENTATION UNIT	PER1309
GRIEVANCE FORM - DEPUTY PROBATION OFFICER UNIT	PER1311
GRIEVANCE FORM - GENERAL REP UNIT	PER1301
GRIEVANCE FORM - GENERAL REPRESENTATION EXTRA HELP UNIT	PER1308
GRIEVANCE FORM - GOVERNMENT ATTORNEYS REPRESENTATION UNIT	PER1306
GRIEVANCE FORM - LAW ENF MID MGT UNIT	PER1304
GRIEVANCE FORM - LAW ENFORCEMENT UNIT	PER1302
GRIEVANCE FORM - MIDDLE MGT UNIT	PER1303
GRIEVANCE FORM - PHYSICIAN'S REPRESENTATION UNIT	PER1307
GRIEVANCE FORM - SHERIFF'S CORRECTIONAL OFFICER REPRESENTATION UNIT	PER1305
GRIEVANCE FORM - SHERIFF'S SUPERVISORY REPRESENTATION UNIT	PER1310
GUIDE TO DEPARTMENTAL SELECTION INTERVIEW	PER3061
HEALTH QUESTIONNAIRE	PER1025
IN-PROCESSING CHECKLIST - EXTRA HELP	PER1019B
IN-PROCESSING CHECKLIST - REGULAR	PER1019A
INCIDENT REPORT FORM - NON EMPLOYEE	PER5012
INTERN SITE AGREEMENT	PER3133
JUSTIFICATION TO HIRE A RETIRED ANNUITANT	PER169
LACTATION INFORMATION	LAC
LONGEVITY DIFFERENTIAL AFFIDAVIT	PER6056
LONGEVITY DIFFERENTIAL AFFIDAVIT - EXTRA HELP	PER6057
LONGEVITY DIFFERENTIAL AFFIDAVIT - GENERAL REP UNIT (SEPARATION FOR ANY REASON OTHER THAN EDUCATION)	PER6058
LONGEVITY DIFFERENTIAL AFFIDAVIT - GENERAL REP UNIT (SEPARATION FOR EDUCATIONAL PURPOSES)	PER6058A
MAP TO AGILE OCCMED	PER1025C
MAP 2 TO CAPITOLA PHYSICAL THERAPY	PER1025D
MEDICAL AUTHORIZATION RELEASE FORM	PER1142
NAME CHANGE FORM	PER1205
NEW EMPLOYEE STATUS & INFO SUMMARY	PER1040
NEW POSITION REQUEST/BOS ACTION	PER3039
NOTIFICATION OF POLICIES	PER1063
PAYROLL CODES - UNFUNDED & PARTIAL YR	PER1208
PAYROLL EMPLOYEE STATUS CODES	PER1201
PERSONNEL LIAISON WELCOME PACKET CHECKLIST FOR EXTRA HELP APPOINTMENTS	PER1020F
PERSONNEL LIAISON WELCOME PACKET CHECKLIST FOR REGULAR APPOINTMENTS	PER1020E
PAYROLL TRANSACTION CODES	PER1200
PAYROLL/PERSONNEL POSITION NUMBER CODES	PER1203
PARENTAL RELEASE FORM (UNDER 18 YEARS OF AGE)	PER1025A
PARTIAL SERVICE RETIREMENT AGREEMENT	PER1900
PARTIAL SERVICE RETIREMENT APPLICATION	CalHR-062
PERSONNEL RECORDS REVIEW FORM	PER3012
PHYSICIAN'S CERT - FMLA	PER1081B
PHYSICIAN'S CERT - LEAVE OF ABSENCE-EMPLOYEE	PER1081A
PHYSICIAN'S CERTIFICATION - RETURN FROM LEAVE	PER1086
POSITION DESCRIPTION FORM - LONG FORM	PER65BF
POSITION DESCRIPTION FORM - SHORT FORM	PER65AF
POSITION DESCRIPTION FORM SUPPLEMENT FOR SUPERVISORY POSITIONS	PER66
PRE-EMPLOYMENT HEALTH QUESTIONNAIRE	PER1025B
PROPERTY LOSS REPORT FORM	PER5013
PROPERTY LOSS REPORT FORM FOR DEPART OF PUBLIC WORKS	PER5013DPW
REASONABLE ACCOMMODATION REQUEST	PER1100A
REFERENCE CHECK - RELEASE/WAIVER FORM	PER3011
REMOVE CANDIDATE FROM LIST REQUEST	PER3151
REQUEST FOR CLASSIFICATION STUDY	PER3116
REQUEST FOR MILITARY LEAVE-ACTIVE DUTY	PER1073
REQUEST PLACE ON EMPLOYMENT TRAINING LIST	PER3161
RESPONSE TO EMPLOYEE REQUEST FOR FMLA LEAVE	PER1085
RETRAINING PAY ADJUSTMENT FORM	PER1206
RIGHTS OF VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT AND STALKING	LCO
SAFETY SUGGESTION FORM	PER6051
SALARY STUDY REQUEST	PER1801
SALARY/COMP/LEAVE - APPTED DEPT HEAD/ASST	PER1041G
SALARY/COMP/LEAVE - BOARD & ELECTED DH	PER1041H
SALARY/COMP/LEAVE - CORRECTION OFF	PER1041I
SALARY/COMP/LEAVE - DA INSPECTOR UNIT	PER1041J
SALARY/COMP/LEAVE - DEPUTY PROBATION OFFICER UNIT	PER1041L
SALARY/COMP/LEAVE - GENERAL REP UNIT	PER1041A
SALARY/COMP/LEAVE - GOVERNMENT ATTORNEYS UNIT	PER1041M
SALARY/COMP/LEAVE - LE & SGTS UNITS	PER1041B
SALARY/COMP/LEAVE - LEMM UNIT	PER1041D
SALARY/COMP/LEAVE - MGT TRAINEES	PER1041E
SALARY/COMP/LEAVE - MID MGT UNIT	PER1041C
SALARY/COMP/LEAVE - OTHER EXECUTIVE MGT	PER1041F
SALARY/COMP/LEAVE - PHYSICIANS' REPRESENTATION UNIT	PER1041K
SEIU SDI INTEGRATION FORM
SEPARATION PACKET	PER5300A
SEPARATION PACKET - EDD	PER5300B
STATE EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE	DE-4
TUITION REIMBURSEMENT FORM - GENERAL REP	PER1360
VEHICLE ACCIDENT REPORT	PER5004
VIP - ACCIDENT FORM	VIP
VIP - ACCIDENT POLICY	VIP
VIP - APPLICATION PACKET	VIP
VIP - AUTO INSURANCE	VIP
VIP - DEPARTMENT REQUEST	VIP
VIP - TIMESHEET	VIP
VIP - TIPS FOR COMPLETING A DEPARTMENT REQUEST FORM	VIP
VOLUNTARY REDUCTION OF HOURS FORM	PER1088
VOLUNTARY TIME OFF FORM	PER1089
WELCOME LETTER EXTRA HELP (NO PHYSICAL)	PER1020C
WELCOME LETTER EXTRA HELP (PHYSICAL)	PER1020D
WELCOME LETTER REGULAR (NO PHYSICAL)	PER1020A
WELCOME LETTER REGULAR (PHYSICAL)	PER1020B
WORKER'S COMP TIME OF HIRE NOTICE	PER1046