Human Resources Forms
Authorized Driver Request Form
Benefit Forms
- Benefit-related forms can be found on the Benefits page under the appropriate benefit name.
Disability and Reasonable Accommodation Form
Injury/Illness Reporting Forms
- Reporting Injuries
- Occupational Clinic Poster
- Concentra West Inland Empire Locations
- Employees Report of Injury Form
- Supervisors Report of Injury Form
- Worker’s Compensation Packet
Payroll Forms
- Makeup Time Request (PDF)
- Meal Period Waiver Agreement – English
- Meal Period Waiver Agreement – Español
- Meal Period Exception Log – English
- Meal Period Exception Log – Español
- HMC Timekeeping Exception Log – English
- HMC Timekeeping Exception Log – Español
Rideshare Forms
Staff Handbook Acknowledgement Form
Tax Withholding Forms
HR Forms Contacts
Please contact any member of the HR team for questions related to HR forms.
Joanna Hernandez
Senior Director for Human Resources
909.621.8512
joahernandez@hmc.edu
Patrice Siffert, SHRM-CP
Associate Director for Human Resources
909.607.4154
psiffert@hmc.edu
Anu Jindal
Payroll Administrator
909.607.2729
ajindal@hmc.edu
Catharyne Magro
Human Resources Coordinator
909.607.9700
cmagro@hmc.edu
Nidia Rivera
Recruiter & HR Generalist
909.607.4096
nirivera@hmc.edu
José Barajas
HR Analyst & Administrator
909.607.6531
jbarajas@hmc.edu
Haley Phillips
Recruiter & HR Generalist (part-time)
909.607.4096
hphillips@hmc.edu