{"id":14,"date":"2013-12-12T08:38:38","date_gmt":"2013-12-12T16:38:38","guid":{"rendered":"http:\/\/www.hmc.edu\/human-resources\/?page_id=14"},"modified":"2025-12-12T12:49:05","modified_gmt":"2025-12-12T20:49:05","slug":"human-resources-forms","status":"publish","type":"page","link":"https:\/\/www.hmc.edu\/human-resources\/human-resources-forms\/","title":{"rendered":"Human Resources Forms"},"content":{"rendered":"\n<div class=\"wp-block-mudd2021-right-sidebar right-sidebar\" id=\"right-sidebar\">\n<h2 class=\"wp-block-heading\">HR Forms Contacts<\/h2>\n\n\n\n<p>Please contact any member of the HR team for questions related to HR forms.<\/p>\n\n\n\n<p><strong>Dana Nagengast, SHRM-SCP<br><\/strong>Assistant Vice President \u2013 Chief Human Resources Officer (AVP-CHRO)<br><a href=\"tel:+19096218512\">909.621.8512<\/a><br><a href=\"mailto:&#100;&#110;&#97;&#103;&#101;ng&#97;s&#116;&#64;hm&#99;&#46;e&#100;u\">&#100;&#110;&#97;&#103;e&#110;&#103;a&#115;t&#64;&#104;m&#99;&#46;&#101;&#100;u<\/a><\/p>\n\n\n\n<p><strong>Patrice Siffert, SHRM-SCP<\/strong><br>Senior Associate Director for Human Resources<br><a href=\"tel:+19096074154\">909.607.4154<\/a><br><a href=\"mailto:&#112;si&#102;&#102;&#101;&#114;&#116;&#64;&#104;mc&#46;edu\">&#112;&#115;&#105;&#102;fe&#114;t&#64;hmc.e&#100;u<\/a><\/p>\n\n\n\n<p><strong>Elsa Barboza<\/strong><br>Human Resources Coordinator<br><a href=\"tel:+19096079700\">909.607.9700<\/a><br><a href=\"mailto:eb&#97;&#114;&#98;o&#122;a&#64;hmc.&#101;du\">e&#98;&#97;rboz&#97;&#64;&#104;mc.&#101;&#100;&#117;<\/a><\/p>\n\n\n\n<p><strong>Haley Phillips<\/strong><br>Associate Director for Human Resources<br><a href=\"tel:+19096074096\">909.607.4096<\/a><br><a href=\"mailto:h&#112;h&#105;l&#108;&#105;&#112;&#115;&#64;hmc.ed&#117;\">&#104;p&#104;i&#108;li&#112;s&#64;&#104;m&#99;.edu<\/a><\/p>\n\n\n\n<p><strong>Jos\u00e9 Barajas<\/strong><br>Assistant Director for Human Resources<br><a href=\"tel:+19096076531\">909.607.6531<\/a><br><a href=\"mailto:&#106;&#98;a&#114;&#97;&#106;a&#115;&#64;hmc.ed&#117;\">&#106;&#98;araja&#115;&#64;h&#109;c&#46;ed&#117;<\/a><\/p>\n\n\n\n<p><strong>Miguel Zuniga<\/strong><br>HR Employment Manager<br><a href=\"tel:+19096074159\">909.607.4159<\/a><br><a href=\"mailto:&#106;&#98;a&#114;&#97;&#106;a&#115;&#64;&#104;m&#99;.e&#100;&#117;\">&#115;oh&#101;rnandez&#64;&#104;m&#99;&#46;edu<\/a><\/p>\n\n\n\n<p><strong>Sophie<\/strong> <strong>Hernandez<\/strong><br>HR\/Payroll Administrator<br><a href=\"tel:+19096076531\">909.607.2729<\/a><br><a href=\"mailto:j&#98;a&#114;&#97;j&#97;&#115;&#64;hmc&#46;e&#100;u\">&#115;&#111;h&#101;rna&#110;d&#101;z&#64;&#104;&#109;c.edu<\/a><\/p>\n\n\n\n<p><strong>Kelly Salazar<\/strong><br>Emergency Preparedness and Safety Supervisor<br><a href=\"tel:+19096079700\">909.607.4891<\/a><br><a href=\"mailto:eba&#114;b&#111;&#122;a&#64;&#104;&#109;&#99;.edu\">&#107;s&#97;&#108;az&#97;&#114;&#64;&#104;mc&#46;&#101;&#100;&#117;<\/a><\/p>\n\n\n\n<p><strong>Garrett Sward<\/strong><br>HR Strategic Initiatives and Systems Specialist<br><a href=\"mailto:gwar&#100;&#64;h&#109;&#99;.edu\"><strong>&#103;&#115;&#119;ar&#100;&#64;h&#109;c&#46;&#101;du<\/strong><\/a><\/p>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Authorized Driver Request Form<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2022\/10\/2022-\u2013-Driver-Authorization_Application-form.pdf\">Authorized Driver Request Form (PDF)<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Benefit Forms<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Benefit-related forms can be found on the <a title=\"Benefits\" href=\"https:\/\/www.hmc.edu\/human-resources\/benefits\/\">Benefits page<\/a>&nbsp;under the appropriate benefit name.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Disability and Reasonable Accommodation Form<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2020\/02\/Reasonable-Accommodation-Form.pdf\">Reasonable Accommodation Form<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"injury-forms\">Injury\/Illness Reporting Forms<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1CLHR__mNmAUGyBUKrkMEkcQhl9kkn42r\/view?usp=sharing\">Reporting Injuries<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2019\/03\/Occupational-Clinic-Poster-2019.pdf\">Occupational Clinic Poster<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2019\/02\/Concentra-West-Inland-Empire-Locations.pdf\">Concentra West Inland Empire Locations<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2021\/11\/Employees-Report-2021.pdf\">Employees Report of Injury Form<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2021\/11\/Supervisors-Report-2021.pdf\">Supervisors Report of Injury Form<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1NBByqMrxiFdhzhECeIH_rBVWf-B8z0h-\/view?usp=drive_link\" data-type=\"link\" data-id=\"https:\/\/drive.google.com\/file\/d\/1NBByqMrxiFdhzhECeIH_rBVWf-B8z0h-\/view?usp=drive_link\">Worker&#8217;s Compensation Packet &#8211; English<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1APyJT7Hr7rGMFDP0DH_dVdlCZcDzRyvz\/view?usp=sharing\">Worker&#8217;s Compensation Packet &#8211; Espa\u00f1ol<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/hmc.kualibuild.com\/app\/666b3b2dca173e013bbbc004\/run\" data-type=\"link\" data-id=\"https:\/\/hmc.kualibuild.com\/app\/666b3b2dca173e013bbbc004\/run\">Workplace Violent Incident Report<\/a> <\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Payroll Forms<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2013\/12\/2014_MakeupTimeRequest.pdf\">Makeup Time Request (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/Meal-Period-Waiver-Agreement-English.pdf\">Meal Period Waiver Agreement &#8211; English<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/Meal-Period-Waiver-Agreement-Spanish.pdf\">Meal Period Waiver Agreement &#8211; Espa\u00f1ol<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/HMC-Meal-Period-Exception-Log-English.pdf\">Meal Period Exception Log &#8211; English<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/HMC-Meal-Period-Exception-Log-Spanish.pdf\">Meal Period Exception Log &#8211; Espa\u00f1ol<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/HMC-TimeClock-Timekeeping-Exception-Log-English.pdf\">HMC Timekeeping Exception Log &#8211; English<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2023\/10\/HMC-TimeClock-Timekeeping-Exception-Log-Spanish.pdf\">HMC Timekeeping Exception Log &#8211; Espa\u00f1ol<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Rideshare Forms<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/hmc.kualibuild.com\/app\/builder\/app\/644863aec39ebc327a1447a7\/run\">Faculty and Staff Rideshare Form (Kuali)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/hmc.kualibuild.com\/app\/builder\/app\/64dd5c87abdd6e0110555fa7\/run\">Faculty and Staff&nbsp;Rideshare Form &#8211; Espa\u00f1ol (Kuali)<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Staff Handbook Acknowledgement Form<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.hmc.edu\/human-resources\/wp-content\/uploads\/sites\/23\/2020\/02\/Employee-Handbook-Acknowledgement-February-2020.pdf\">Employee Handbook Acknowledgement Form<\/a> (PDF)<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Tax Withholding Forms<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.irs.gov\/pub\/irs-pdf\/fw4.pdf\">Form W-4 Federal Tax Withholding Form (PDF)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.edd.ca.gov\/pdf_pub_ctr\/de4.pdf\">Form DE-4 State Employee&#8217;s Withholding Allowance Certificate (PDF)<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Authorized Driver Request Form Benefit Forms Disability and Reasonable Accommodation Form Injury\/Illness Reporting Forms Payroll Forms Rideshare Forms Staff Handbook [&hellip;]<\/p>\n","protected":false},"author":277,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-14","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/pages\/14","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/users\/277"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/comments?post=14"}],"version-history":[{"count":18,"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/pages\/14\/revisions"}],"predecessor-version":[{"id":6016,"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/pages\/14\/revisions\/6016"}],"wp:attachment":[{"href":"https:\/\/www.hmc.edu\/human-resources\/wp-json\/wp\/v2\/media?parent=14"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}