Forms

Note: If you receive an error when trying to access a PDF file it means you need to download the PDF and open in Acrobat

HR Request Form

Please send all request you would normally send to your HR Consultant using the HR Request form. This includes Acting-In, Career Mobility, Incentive Plans, In-Grad and Grade Advancements, Job Description, Salary Reviews, Pay Equity Reviews, Reclassifications and Recruitment. Please attach the required documents

Administration

Administration
File	Size
2021 Holiday Schedule	588 kB
2022 Holiday Schedule	134 kB
Career Mobility Agreement	170 kB
Gift Card Request	2374 kB
Termination Checklist	40 kB
Training Repayment Agreement	134 kB
New Employee Onboarding Packet (for supervisors)	2419 kB

Report an On-The-Job Injury or Illness

Benefits

Benefits
File	Size
PEHP Group Term Life Change Form	255 kB

Classification

Classification
File	Size
Classification Appeal Hearing Officer Manual	138 kB
Condensed Position Description Questionnaire	269 kB
Job Description Template	58 kB
Position Classification Appeal Hearing Officer	170 kB
Position Classification Appeal Staff Review	159 kB
Position Description Questionnaire	4304 kB

Employee Relations

Employee Relations
File	Size
Alcohol and Drug Reasonable Suspicion Checklist	1585 kB
Designation of Representative	153 kB
Disclosure of Prescription Drugs	177 kB
Drug Screening Authorization Form	156 kB
EEO Complaint Form - Submit	225 kB
EEO Complaint Form - Withdraw	149 kB
Employee Grievance Form	150 kB
Employee Disciplinary Notice of Written Warning	1602 kB
Mediation Agreement Form	1527 kB
Employee Disciplinary Notice Intent to Demote - Letter Template	25 kB
Employee Disciplinary Notice Suspend Without Pay - Letter Template	27 kB
Employee Disciplinary Notice Terminate - Letter Template	25 kB
Request for Appeal Hearing, Appeal Pre-Filing Form	1596 kB
Workplace Violence Statement Form	133 kB
Conflict of Interest - Salt Lake County Disclosure Statement	309 kB

FFCRA leave request form (including requests for Emergency responders and Healthcare providers)

Employee Relations- ADA

Employee Relations- ADA
File	Size
ADA Intake Form	1595 kB
ADA HIPAA Form	1597 kB
ADA Interactive Process Worksheet (for Agency use only)	1593 kB
ADA Medical Information Questionnaire	1597 kB

Employees' University

Employees' University
File	Size
Software Training Agreement	181 kB
Tuition Reimbursement Application	294 kB

Family Medical Leave (FMLA)

Family Medical Leave (FMLA)
File	Size
Designation Notice - FMLA	189 kB
Employee's Serious Health Condition	247 kB
Family's Serious Health Condition	199 kB
Family Medical Leave Request Form	250 kB
Military Family Leave Qualifying Exigency	164 kB
Notice of Eligibility- Rights and Responsibilities - FMLA	310 kB

Pay Policy Forms

Pay Policy Forms
File	Size
Bonus Award Letter-Example	41 kB
Incentive Plan	144 kB
In-Grade Advancement Plan	202 kB
Salary Recommendation Form	547 kB

Payroll and New Hire

Payroll and New Hire
File	Size
Acting in Position Agreement	218 kB
Criminal Records Name Check and Fingerprint Check Waiver	228 kB
Criminal Records Billing	199 kB
ePar Approver Request	206 kB
ePar Deadlines 2021	244 kB
ePar Deadlines 2022	387 kB
Form I-9 Employment Eligibility Verification (Spanish) - HR Use Only	326 kB
Mileage Reimbursement	69 kB
Contract - Notice of Appointment Time Limited Employee	191 kB
On-Call and Call Back Pay	225 kB
Overtime Compensation Agreement Form	160 kB
Payroll Access Form	191 kB
Release of Information Form-49 CFR Part 40 Drug and Alcohol Testing For FMCSA RegulatedEmployers	15 kB
Snow Removal Agreement	166 kB
Utah Retirement Systems Leave Notification (MELV-2)	81 kB
Workflow Approval List	233 kB
Workflow Approver Request	159 kB
Workflow Form	832 kB
New Hire Information – Appointed /Elected /Time-Limited	310 kB
New Hire Information – Merit/Sworn	244 kB
New Hire Information - Temporary	246 kB
ePAR Guide Approver Instructions	178 kB
ePAR Guide Initiator Instructions	205 kB
ePAR FAQs	77 kB
W-4, Current Year	173 kB
Internship Agreement Form	180 kB

Performance and Development

Performance and Development
File	Size
COVID-Supplemental PDP for Redployed/Reassigned Employees	220 kB
Performance Improvement Plan	56 kB
Performance Plan and Appraisal	1435 kB
Pro-Rate Annual Appraisal Calculation	1593 kB

Recruitment

Recruitment
File	Size
Exception to Fill Vacancy Form	151 kB
ADP/Recruiting Management Access	194 kB
Reference Release	290 kB
Template for Reference Check Questions	430 kB