Forms

These forms are presented as Microsoft WordTM templates so they can be completed electronically. To complete the form, download the template and type the information requested in the appropriate fields. Then use “Save As” under Word’s file menu to save the completed form as a Word document file.

Quick Links

• Discrimination, Harassment & Retaliation Complaint Form (PDF)
• Employee Relations Complaint Form (PDF)

All Forms

• Accident Investigation and Prevention Report
• Certification of Health Care Provider for Employee’s Serious Health Condition – FMLA (PDF)
• Certification of Health Care Provider for Family Member’s Serious Health Condition – FMLA (PDF)
• Conflict of Interest and Ethics (PDF)
• Discrimination, Harassment & Retaliation Complaint Form (PDF)
• Domestic Partners Affidavit for Group Insurance (PDF)
• Domestic Partners Affidavit for Tuition Remission (PDF)
• Educational Assistance Application (PDF)
• Educational Assistance Application CGU (PDF)
• Employee Corrective Action (PDF)
• Employee Information Release Form (PDF)
• Employee Relations Complaint Form (PDF)
• Faculty Contract for Tenured Faculty (PDF)
• Faculty Contract for Tenure-Track or Non-Tenured Faculty (PDF)
• Faculty Contract Salary & Workload Agreement for Tenured Faculty (PDF)
• Faculty New Hire Checklist Form for New Faculty Packets (Word docx)
• Health Club Membership Reimbursement Form (PDF)
• HCP Credentialing Checklist Dental 5-03-2021 (Word docx)
• HCP Credentialing Checklist DO-MD-DPM-PT-NP-PA 5-01-2021 (Word docx)
• HCP Credentialing Checklist Optometry rev 05-01-2021 (Word docx)
• Hiring Supervisor’s Orientation Checklist (PDF)
• Interviewer’s Guide and Report (PDF)
• Kudos and Suggestions (web form)
• Mandated Reporter Form (Word doc)
• Mentor Guide to the Title IX Process (PDF)
• Mentor Request Title IX Process (PDF)
• Multi-Year Non-Tenure Track Faculty Contract (Word docx)
• New Employee Safety Training Record (Word template)
• New Hire Checklist (html form)
• Non-Tenure Track Multi-Year Workload Agreement  (PDF)
• Notice of Adjunct Faculty Limited Appt (PDF)
• Notice of Faculty Appointment and Agreement of Employment (PDF)
• Offer Letter – Administrative Position (Word docx)
• Offer Letter – Auxiliary Faculty Appointments (Word docx)
• Offer Letter – Healthcare Provider Worker & WesternU Health (Word docx)
• Offer Letter – Regular Faculty Appointments (Word docx)
• Offer Letter – Post Doctoral Fellow (Word docx)
• Offer Letter – Staff Position (Word docx)
• Offer Letter – Temporary Position (Word docx)
• Offer Letter – Regular Faculty & WesternU Health Appointments (Word docx)
• PeopleAdmin User Authorization (PDF)
• Performance Appraisal – Sharepoint Annual Evaluation
• Performance Appraisal (Special) for Employee Development-Exempt (Excel file)
• Performance Appraisal (Special) for Employee Development-Non-Exempt (Excel file)
• Performance Appraisal – PeopleAdmin Annual Evaluation – Employee’s Quick Guide (PDF)
• Performance Appraisal – PeopleAdmin Annual Evaluation – Supervisor’s Quick Guide (PDF)
• Performance Evaluation_Performance Factor Comments (Word doc)
• Performance Evaluation – 90 Day Introductory Period (PDF)
• Performance Evaluation-Quarterly Self Evaluation for Exempt Employee (Word docx)
• Performance Evaluation-Quarterly Self Evaluation for Non-Exempt Employee (Word docx)
• Performance Improvement Plan (Word doc)
• Personnel File Inspection Request form (PDF)
• Position Description Questionnaire (Word docx)
• Position Request Form Template (PDF)
• Practicing Physician Agreement (Word docx)
• Rationale Statement (PDF)
• Reports Request Form (PDF)
• Rideshare Online Incentive Form (online form)
• Statement of Termination of Domestic Partnership (PDF)
• Telecommuting Agreement (PDF)
• Tuition Remission Application (PDF)
• Tuition Remission Grandfather Benefit Chart (PDF)
• University of LaVerne Partnership in Education Form (PDF)
• Volunteer Registration Form (PDF)
• Weight Watcher’s Reimbursement Form (PDF)
• WesternU 403(B) Summary Plan Description (Login Required-PDF)
• WHCRA Notice (Word doc)
• Workers Compensation Forms – California (PDF)