Human Resources Forms

Authorized Driver Request Form

• Authorized Driver Request Form (PDF)

Benefit Forms

• Benefit-related forms can be found on the Benefits page under the appropriate benefit name.

Disability and Reasonable Accommodation Form

• 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 – Spanish
• Meal Period Exception Log – English
• Meal Period Exception Log – Spanish
• HMC Timekeeping Exception Log – English
• HMC Timekeeping Exception Log – Spanish

Performance Evaluation Forms

• Performance Evaluation Forms and related documents can be found on the Performance Evaluation page.

Rideshare Forms

• Biweekly-Paid Staff Rideshare Form (Online)
• Monthly-Paid Faculty and Staff Rideshare Form (Online)
• Rideshare Form (All Faculty and Staff) (PDF)

Staff Handbook Acknowledgement Form

• Employee Handbook Acknowledgement Form (PDF)

Tax Withholding Forms

• Form W-4 Federal Tax Withholding Form (PDF)
• Form DE-4 State Employee’s Withholding Allowance Certificate (PDF)