Employee Forms

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

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, Full-Time Faculty, Part-Time Faculty)
• Load Banking Forms (Faculty)
• Part-Time Instructor Office Hours Verification Form (Part-Time Faculty)

Department Use Forms

For questions, contact Christine Winterle cwinterle@palomar.edu.

• Action Form for Short-term Employees
• Action Form for Student Employees
• Request/Recommendation for Volunteer Service Form
• 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)
• Recruiting/Job Posting Forms
• 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 Human Resource Services if you have questions or need further support at HRhelp@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 (EV, LS/FRM, Exch, UA, Ret, PD, TB, STMLSFrm)

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