Contents
Cal Poly Pomona

Payroll Forms

Attendance Processing & Reporting

PDF Help Absence and Additional Time Worked Request - Form Std. 634
To report absences for faculty and staff
PDF Help Time and Attendance Report - Form 672
Not available in PDF format, must be able to print to ledger size paper (11"x17") .
PDF Help Advance Request for Authorization of Paid Overtime
To report paid overtime worked for non-exempt employees
PDF Help Advance Request for Authorization of Premium Overtime - CTO
To report CTO worked by non-exempt employees
PDF Help Holiday Credit Form
To document holiday credit for employees who work an irregular work schedule and the holiday falls on their normal day off
PDF Help Excess Hours Paid
To report excess hours to be paid to employees on an irregular work schedule
PDF Help Excess Hours Reconciliation
To reconcile employees' deficit hours each calendar year in December.
PDF Help Holiday Closure Work Authorization
To report work performed during holiday closure
PDF Help Hourly Time Voucher
To report hours worked by intermittent (hourly) employees
PDF Help Request For Irregular Work Schedule - 7 Day Work Week
To document an employee's work schedule that is other than Monday thru Friday
PDF Help Request For Irregular Work Schedule - 14 Day Work Week
To document an employee's work schedule that is other than Monday thru Friday
PDF Help Signature Authorization - Faculty/Staff Payroll
To establish signature records on file of employees who are authorized to certify faculty and staff attendance.

Leave of Absence

Icon indicating this is a Word document.

Leave of Absence Form (Word) * Leave of Absence Form Instructions

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Catastrophic Leave Donation Program Application

Icon indicating this is a Word document. Family Medical Leave Notice & Request Form
Icon indicating this is a Word document. Medical Certification Form

 

Clearance Forms

PDF Help
Clearance Form
Used to clear separating employees.
PDF Help PST Retirement Refund Request - Form - Std. 951
Disposition of PST retirement funds
Additional Notes - Must be signed by an authorized HRS employee before mailing to Sacramento 

Faculty & Staff - Miscellaneous Forms

PDF Help
Information Access and Confidentiality Form
Employee information and certification form regarding awareness of state laws, federal laws, and University policies governing access to and use of student and employee personal information.
PDF Help
Designation of Person Authorized To Receive Warrants
Designates person who is entitled to receive any outstanding warrants upon the employee's death.
Additional Notes -This form must be signed in the Customer Service Center.
PDF Help Direct Deposit Form - Form - Std. 699
Enrollment authorization form.
PDF Help Employee Action Request (E.A.R.) - Form - Std. 686
Reporting the following personal changes:
Name
Withholding Allowances
Address
Additional Information - Please confirm with the HR& Payroll Services - Customer Service Center (ex: 3733) that no additional documentation is required before submitting this form.
PDF Help Personal Data Sheet
Personal Data Form
Icon for MS Office Word User Access Form - PeopleSoft HCM
PDF Help U.S. Savings Bond Deduction
To add or change Savings Bonds deductions
PDF Help W-2 (Request Duplicate)
To request a duplicate Wage & Tax Statement (W-2 Form)
There is a $8.50 processing fee per tax year requested.

Student Payroll Forms

PDF Help Student Assistant Attendance Report (CD048)
To report hours worked for all student worker classifications (No preprinted data)
PDF Help Student Assistant & Bridge Student Assistant Time Voucher
To report hours worked to supervisors, or to track hours worked
PDF Help

Student Assistant Federal Work Study Timesheet
To report hours worked to supervisors, or to track hours worked

PDF Help Student Assistant Attendance Signature Authorization Form - Student Payroll
Vice Presidents, Associate VPs, Deans, & Directors authorize staff to certify all student assistant classifications, and work study student attendance.
PDF Help W-2 (Request Duplicate)
To request a duplicate Wage & Tax Statement (W-2 Form)

Instructions for Using & Printing Forms

The following forms are provided for your convenience. All forms are available in Adobe PDF Format. You will need Adobe Acrobat Reader version 3.0 or higher to view/print the forms. You may download the reader from Adobe's download site.

Link to "Get Adobe Acrobat Reader"

Help with Viewing and Printing PDF Forms For Forms Accessibility Issues please visit Adobe's Accessibility Site at http://access.adobe.com/.

 

Please Note:
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