| Alcohol and Controlled Substance Testing Program for Commercial Drivers
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This program applies to employees who operate a commercial motor vehicle in interstate or intrastate commerce and are subject to the commercial driver’s license (CDL) requirements of the State of California. Every employee who is required to maintain CDL to operate a commercial motor vehicle is subject to this policy.
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Check with your supervisor to determine if you are subject to this program.
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| Authorization to Use Privately Owned Vehicles on State Business (Std 261) (PDF Form)
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Authorizes employees to operate privately owned vehicles during State Business. Employee must certify possession of valid driver’s license and appropriate liability insurance. Supervisor retains original, forward a copy to Accounting.
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If applicable, at supervisor’s discretion (check with your supervisor to see if this applies).
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| Beneficiary Designation (PERS-BSD-241)
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Designates beneficiaries for payments of specific Death Benefits. To be mailed directly to CalPERS.
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Within 2 days
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X
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X
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CalATERS System Authorization Form
(FG ASB-586)
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To authorize employees to use the CalATERS System to submit travel advances and/or reimbursement for travel expenses incurred in the service of the State.
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Within 30 days
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X
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X
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X
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| California’s Programs for the Unemployed (PDF)
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Information on programs offered by the Employment Development Department (EDD) for the benefit of unemployed Californians. Includes information on California’s Unemployment Insurance, Disability Insurance, Paid Family Leave, and Workforce Services.
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FYI only
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X
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X
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CalPERS Health Plan Decision Guide & Health Benefit Summary
Health Benefit Enrollment Form (PERS-HBD 12) (PDF)
Declaration of Health Coverage Form (PERS-HBD 12A) (PDF Form)
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Information on various health plans, eligibility and enrollment.
Health enrollment forms must be submitted to the Personnel Office to process your enrollment.
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Within 60 days
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You must have a permanent appointment and work at least half time to be eligible for this benefit. Limited Term (LT) appointments must have a duration of more than six months to be eligible. State Permanent-Intermittent (PI) employees may enroll if they have worked a minimum of 480 paid hours during each six-month qualifying control period ending June 30 and December 31.
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| Dental Benefits Information
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Information regarding State-sponsored dental coverage for eligible State employees and their dependents.
See additional dental benefit information on the CalHR website.
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FYI only
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X
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X
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Dental Plan Enrollment Authorization form (Std 692) (PDF Form)
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The Dental Plan Enrollment form must be submitted to the Personnel Office to process your enrollment.
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Within 60 days
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Permanent employees who work the equivalent of half time and or more; PI employees who work a minimum of 480 paid hours during six month qualifying control period ending June 30 and December 31; and LT and Temporary Authorized employees appointed to positions of six months or more and at a time base of half time or more are eligible for this benefit.
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| Direct Deposit Enrollment Authorization (Std 699) (PDF Form)
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Direct Deposit automatically deposits your net earnings into the financial institution of your choice. Once you enroll, all your payments, including supplemental payments such as overtime, awards/bonuses, etc., are transferred to your financial institution.
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Any time
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X
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X
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X
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| Emergency Information Form (DFW 253) (PDF Form)
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Emergency contact information in the event of employee injury or illness at work.
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Within 2 days
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X
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X
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X
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| Employee Action Request (Std 686) (PDF Form)
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To input or update various personnel related data (i.e., name, home address, marital Status/Exemptions for tax withholding purposes.)
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Within 2 days
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X
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X
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| Employee Assistance Program (EAP)
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Through CalHR’s EAP, employees can receive assistance for: Alcohol Abuse, Drug Abuse, Marital and Family Issues, Emotional, Personal and Stress Concerns and Financial and Credit Issues.
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Any time
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Permanent full-time or part-time regardless of their bargaining unit designation are eligible for EAP services. Seasonal and limited-term employees and retired annuitants are eligible for EAP services during employment.
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| Employee’s Designated Headquarters (DFW 202) (PDF Form)
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Pursuant to State Administrative Manual Section 0700 and CalHR Regulation 599.616(a), all employees are required with their supervisor’s approval to designate their headquarters, defined as the place where the employee spends the largest portion of his/her regular workdays or working time, or the place to which he/she returns on completion of special assignments.
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Within 2 weeks
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X
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X
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X
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| Employment Eligibility Verification (I-9) (PDF Form)
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Federal form for documenting all new employees. Employees will not be allowed to work until this form is submitted to the HRB.
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Prior to start date
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X
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X
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| Federal Firearms Prohibition (FG-HRB- 2026) (PDF)
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The Omnibus Consolidated Appropriations Act of 1997 entitled the “Gun Ban for Individuals Convicted of a Misdemeanor Crime of Domestic Violence,” which amended the Gun Control Act of 1968, prohibits any person who has been convicted of “misdemeanor crime of domestic violence” from shipping, transporting, possessing, or receiving firearms or ammunition. All candidates of employment are required to complete a Self-Certification and Certification of Receipt of Memorandum form.
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Prior to start date
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X
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X
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X
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| FlexElect Reimbursement Accounts
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Information on voluntary plan in which State employees can set aside money in a reimbursement account to pay for certain medical and dependent care expenses.
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Within 60 days
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X
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X
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| Group Legal Services Plan
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Information on Group Legal Services Plan, a voluntary employee-paid plan. Premiums are paid through monthly payroll deductions.
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Within 30 days
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X
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X
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| Long-Term Disability (LTD) Insurance for Excluded Employees
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Information on Long-Term Disability Insurance, which can supplement other income protection plans (PERS Disability Retirement, Social Security, etc.)
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Employees designated Managerial, supervisory, and Confidential are eligible for this benefit
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| Military Service Declaration (Std 912) (PDF Form)
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Military service may qualify employees for certain benefits during their careers with the State of California. The State will determine if you qualify.
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Within 2 days
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X
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X
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| Oath of Allegiance (Std 689) (PDF Form)
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Every State employee must complete this form before entering upon the duties of State employment.
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Within 2 days
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X
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X
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| Oath of Office (Std 688) (PDF Form)
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Every Exempt employee must complete before entering upon the duties of an appointment.
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Exempt employees only
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| Part-time, Seasonal, or Temporary (PST) Retirement Program
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The PST Retirement Program is a mandatory retirement savings program for employees not covered by the CalPERS retirement system. You are automatically enrolled if you are not covered under CalPERS.
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Part-time, seasonal and temporary employees are eligible for this program
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| Designation of Person Authorized to Receive Warrants (Std 243) (PDF Form)
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To designate a person who shall be entitled upon your death to receive all outstanding state warrants.
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Within 2 days
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X
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X
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| Department Policies
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The Equal Opportunity & Sexual Harassment Prevention, Incompatible & Political Activities, Personal Use of State Vehicles, Family and Medical Leave, CDFW_All Email, Social Security Number & Other Personnel Data and Protecting the Confidentiality of Personal Data Policies
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Within 2 days
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X
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X
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X
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| Request for Nondisclosure of Employee Home Address (Std 677) (PDF Form)
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Employees may request that their home address not be disclosed as provided in Government Code Section 6254.3 (b).
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Within 2 days
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X
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X
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| Savings Plus Program (SPP)
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Information about the Savings Plus Program, which a 401(k) Plan and a 457 Plan to eligible State of California employees. Such plans provide for retirement savings that is not taxed until you withdraw it, generally during retirement.
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Any time
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X
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X
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| State Employee Disability Questionnaire
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The State Personnel Board (SPB) is dedicated to ensuring that fair and equal treatment is provided to all state employees. The following survey was developed to identify the number of employees with disabilities currently employed at your department and throughout our state workforce. Information collected is used to assist departments to identify if they are meeting their goal of having an equitable representation of persons with disabilities.
Although your response is voluntary, your participation is essential to the State achieving its goals. Your identity will be kept confidential and will not be shared with your department.
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Within 2 days
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X
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X
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| State Employee Race/Ethnicity Questionnaire (SPB 1070) (PDF Form)
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All new/rehired employees are requested to voluntarily self-identify their race/ethnicity and gender in order to monitor and evaluate the provision of equal employment opportunity and non-discriminatory employment practices within the State civil service.
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Within 2 days
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X
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X
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| Statement of Economic Interest (Form 700)
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CDFW’s Conflict of Interest Code requires employees in designated classifications to file a Form 700. The code, affected classifications, form and disclosure requirements will be provided upon employment by the employee's personnel specialist.
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Within 2 weeks
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X
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X
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X
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| Vision Benefits (Std 700) (PDF Form)
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Permanent State employees working half-time or more are eligible for the State's Vision Program. Benefits include yearly eye examinations and eyeglasses/corrective lenses. More information about vision benefits.
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Automatic enrollment
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Permanent State employees working half-time or more are eligible for the State's Vision Program.
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| Voyager Fuel Card – Acknowledgment of Responsibility (FG-BMB-585)
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Employees required to drive a CDFW’s vehicle to conduct official state business must obtain a Personal Identification Number (PIN) to use with CDFW Voyager Fuel Cards for fuel purchases. To obtain a driver PIN, employees must complete the Acknowledgment of Responsibility Form.
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If applicable, at supervisor’s discretion (check with your supervisor to see if this applies).
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| Workers’ Compensation Pre-Designation (DFW 544) (PDF Form)
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Complete a Workers’ Compensation Pre-Designation Form to pre-designate your regular personal physician or personal medical group as the primary care physician or medical treatment group in case of a work related injury.
If an employee does not designate a care provider, the State will provide quality medical treatment through the State Fund Medical Provider Network (MPN). See the following for more information:
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At the time of hire
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X
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X
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X
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