Forms

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Administration

Administration
File	Size
2020 Holiday Schedule	406 kB
Career Mobility Agreement	181 kB
First Report of Injury	303 kB
Gift Card Request	2374 kB
Termination Checklist	40 kB
Training Repayment Agreement	134 kB
New Employee Onboarding Packet (for supervisors)	2419 kB

Benefits
File	Size
PEHP Group Term Life Change Form	255 kB

Classification
File	Size
Condensed Position Description Questionnaire	99 kB
Job Description Template	58 kB
Position Description Questionnaire	3010 kB

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	1465 kB
EEO Complaint Form - Withdraw	149 kB
Employee Grievance Form	159 kB
Employee Disciplinary Notice of Written Warning	1602 kB
FFCRA Leave Request Form	99 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	374 kB

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
File	Size
Software Training Agreement	181 kB
Tuition Reimbursement Application	294 kB

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

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 Deadline Calendar	1740 kB
Form I-9 Employment Eligibility Verification (Spanish) - HR Use Only	326 kB
Mileage Reimbursement	69 kB
Contract - Notice of Appointment Time Limited Employee	159 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	680 kB
New Hire Information – Appointed /Elected /Time-Limited	310 kB
New Hire Information – Merit/Sworn	244 kB
New Hire Information - Temporary	246 kB
ePAR Approval	524 kB
ePAR FAQs	77 kB
ePAR Initiate Hire Rehire	459 kB
W-4, Current Year	173 kB
Internship Agreement Form	125 kB

Performance and Development
File	Size
Performance Improvement Plan	56 kB
Performance Plan and Appraisal	1435 kB
Pro-Rate Annual Appraisal Calculation	1593 kB

Recruitment
File	Size
Exception Approval to Hire Request Form2	223 kB
Exception to Fill Vacancy Form	172 kB
ADP/Recruiting Management Access	194 kB
Reference Check Release Form	290 kB
Template for Reference Check Questions	430 kB
REC_TRH_MH	135 kB
REC_TRH_MT	82 kB

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