Employee Forms

• Address/Name Change Form
• ASL Interpreter/CART Service Agreement
• ASL Interpreter/CART Service Request Form
• COVID-19 Telework Agreement
• COVID-19 Vaccine Medical Exemption Form
• COVID-19 Vaccine Religious Exemption Form
• Employee Accommodation Request
• Notice of Separation
• Personnel File Review Request
• Payroll Forms (W4, Direct Deposit, Check Release, Sick Leave Transfer request, etc.)

Please see the Personnel Information page for the appropriate employee group for the following forms:

• Employee Evaluation Forms (Administrators, CAST, Classified)
• Catastrophic Leave Request/Donation Forms (Administrators, CAST, Classified)
• Load Banking Forms (Faculty)
• Part-Time Instructor Office Hours Verification Form (Part-Time Faculty)

Department Use Forms
Questions contact Christine Winterle ex.2674

• Actions forms for Short-terms/Students/Volunteers
• Bilingual Interpreters List
• Bilingual Stipend Request
• Out of Classification Request for Expanded Duties – Use this form to request out-of-classification pay for expanded duties (duties performed at a higher level)
• Shift Differential Request – Use this form to begin/change/end a shift differential

Position Request and Classification Forms

• Position Authorization Request – After you complete the form (#1-4), please route for all signatures (#5-9) in order via Adobe Sign.
• Out-of-Classification Replacement Request – This form is to be used to request a full out-of-class replacement for a vacant position.
• Classified Reclassification Request – Classified employees or their supervisors may use this form to request reclassification of classified positions. Please contact Shawna Cohen if you have questions or need further support at ext. 2608 or scohen@palomar.edu.

Benefit Forms

• 403(b) and 457(b)
  • Salary Reduction Agreement
• Dental Forms
  • Delta PPO Plan Summary
  • DeltaCare USA Plan Summary
  • DeltaCare USA Enrollment, Delta PPO Enrollment, DPO claim form
• Life, Long-Term Care, Long-Term Disability Forms
  • Life Beneficiary Form, How to file a claim
  • Voluntary Life and AD&D
  • LTC Claim Form, LTC District paid Enrollment, LTC Optional Enrollment
  • LTD How to file a claim
• Medical and Vision Forms
  • Marriage Affidavit, Waive Medical Benefits
  • Kaiser HMO Enrollment, Kaiser HSA Enrollment, Kaiser out of area student, Kaiser Travel
  • Anthem HMO Enrollment, Anthem PPO Enrollment, PPO Claim Form(fax 866/444-3816), PPO Transition Care, Mail Order Rx
  • EyeMed Enrollment Form
  • Health Insurance Opt Out Form
• Retirement Forms
  • APPLE Beneficiary, APPLE Distribution Form
  • PERS Beneficiary, PERS Service Credit Purchase, PERS Service , PERS Retirement , PERS Power of Attorney
  • STRS Beneficiary, STRS Service Credit Purchase, STRS Service Retirement
• Voluntary Benefit Forms
  • Hyatt Enrollment Form
• Orientation Information
  • EDD, FacSal, Work Injury, Pre-Desig,Med, Hol, 30D, Cdue, Fdue,HIPAA, Ltax,COB,Scert, casto, crtadmo, clsadmo, classo, faco, eceo, HShelp, HSlogin, rskassess,TBEnc

Leave Forms

• Request for Family Medical Leave
• Request for Personal Leave
• Certification of Health Care Provider Form – Employee’s Illness
• Certification of Health Care Provider Form – Family Member

Workers’ Compensation Forms

• Follow the link here – forms are listed under “Resources”.

Policy Forms (Palomar College Policies and Procedures)

• Academic Due Process (Faculty)
• Grievance/Complaint Forms Forms by employee group – Administrators, CAST, Classified, Faculty