{"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;na&#103;&#101;n&#103;&#97;st&#64;hm&#99;.ed&#117;\">&#100;&#110;a&#103;eng&#97;&#115;t&#64;&#104;m&#99;&#46;ed&#117;<\/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;fe&#114;&#116;&#64;hmc.&#101;d&#117;\">&#112;si&#102;f&#101;r&#116;&#64;hmc&#46;&#101;du<\/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:e&#98;&#97;rb&#111;&#122;&#97;&#64;&#104;mc&#46;e&#100;u\">&#101;ba&#114;b&#111;z&#97;&#64;h&#109;c.&#101;&#100;u<\/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:&#104;ph&#105;&#108;&#108;&#105;ps&#64;&#104;mc.ed&#117;\">h&#112;&#104;&#105;&#108;&#108;ips&#64;&#104;mc&#46;&#101;du<\/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:jb&#97;ra&#106;as&#64;h&#109;&#99;.ed&#117;\">j&#98;a&#114;a&#106;&#97;s&#64;h&#109;&#99;&#46;e&#100;u<\/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:jbarajas&#64;hm&#99;&#46;e&#100;&#117;\">&#115;o&#104;ern&#97;nd&#101;&#122;&#64;&#104;mc&#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:jba&#114;aja&#115;&#64;&#104;mc&#46;e&#100;u\">&#115;&#111;&#104;er&#110;&#97;n&#100;&#101;&#122;&#64;hm&#99;&#46;&#101;d&#117;<\/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:&#101;&#98;ar&#98;&#111;za&#64;hm&#99;&#46;edu\">ksa&#108;a&#122;ar&#64;h&#109;c.&#101;&#100;u<\/a><\/p>\n\n\n\n<p><strong>Garrett Sward<\/strong><br>HR Strategic Initiatives and Systems Specialist<br><a href=\"mailto:g&#119;ar&#100;&#64;&#104;mc&#46;edu\"><strong>&#103;&#115;&#119;a&#114;&#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}]}}