HR Forms and Checklists

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D-F Forms

  • Day of Rest - Acknowledgement and Waiver
    Personalize
    ​Provide this form for employees to acknowledge and waive their right to one “day of rest” in each seven-day workweek. ​Employers cannot take any action to encourage employees to waive their right to a day of rest. However, an employer can allow an employee to choose not to take a day of rest, as long as the employee is fully informed of his/her right.
  • DE4 - California Employees Withholding Certificate
    Free
    Copy and distribute this form from the EDD to employees so they can determine their withholding allowances.​​
  • Deceased Employee Compensation Collection Form
    Provide this form to the surviving spouse, registered domestic partner, guardian or a conservator of an estate (Affiant) in order to allow collection of the decedent's salary or other compensation.​
  • Defining Harassment Quiz
    Use this quiz as a training tool during sexual harassment training for employees.​
  • Direct Deposit Authorization
    Give this form to an employee who requests his pay delivered by direct deposit to one or more bank accounts. Before distribution, indicate the maximum number of direct deposit accounts and financial institutions.
  • Direct Deposit Authorization - Spanish
    Give this form to an employee who requests his pay delivered by direct deposit to one or more bank accounts. Before distribution, indicate the maximum number of direct deposit accounts and financial institutions.
  • Disclosure and Authorization to Obtain Consumer Credit Report – California

    ​In California, credit reports can only be used for employment purposes in specific limited circumstances. If allowed, use this form to provide disclosures required by California law and to obtain written authorization from an individual before obtaining a credit report for employment purposes. Provide this form along with the Disclosure and Authorization to Obtain Consumer Credit Report – Federal. Download and read the Instructions prior to using this disclosure and authorization.

    Instructions​​​​​
  • Disclosure and Authorization to Obtain Consumer Credit Report – California – Instructions
    Download and read these Instructions prior to using Disclosure and Authorization to Obtain Consumer Credit Report – California.​​​​
  • Disclosure and Authorization to Obtain Consumer Credit Report – Federal
    Use this form to provide disclosures required by federal law and to obtain written authorization from an individual before obtaining a credit report for employment purposes. For applicants located in California, provide this form along with the Disclosure and Authorization to Obtain Consumer Credit Report – California.
  • Disclosure and Authorization to Obtain Investigative Consumer Report – California
    Use this form to provide disclosures required by California law and to obtain written authorization from an individual before obtaining an investigative consumer report for employment purposes. Provide this form along with the Disclosure and Authorization to Obtain Consumer Credit Report – Federal.

    Employers subject to the San Francisco Fair Chance Ordinance must also provide a city-specific notice of rights before conducting a criminal background check.
  • Disclosure and Authorization to Obtain Investigative Consumer Report – Federal
    Use this form to provide disclosures required by federal law and to obtain written authorization from an individual before obtaining an investigative consumer report for employment purposes. For applicants located in California, provide this form along with the Disclosure and Authorization to Obtain Consumer Credit Report – California.

    Employers subject to the San Francisco Fair Chance Ordinance must also provide a city-specific notice of rights before conducting a criminal background check.
  • Doctors First Report of Occupational Injury or Illness
    After an injured employee's first doctor's visit, the doctor completes this report and sends two copies to the employer's workers' compensation insurance carrier or the self-insured employer within five days of the initial examination. Failure to file a timely doctor's report may result in assessment of a civil penalty.​​
  • Domestic Violence/Sexual Assault/Stalking Checklist
    This form will help guide you through providing leave for an employee who has notified you that he or she has become a victim of domestic violence. ​​​
  • Earned Income Tax Credit - Employer Required Notification
    Provide this form to employees along with their W-2 or 1099 to notify them of their rights under the federal and California Earned Income Tax Credit (EITC) program.
  • Earned Income Tax Credit - Employer Required Notification - Spanish
    Provide this Spanish​ form to employees along with their W-2 or 1099 to notify them of their rights under the federal and California Earned Income Tax Credit (EITC) program.
  • Education Leave Checklist
    Use this checklist to create and implement an education leave policy for your company.
  • Emergency Action Plan
    Personalize
    Use this form to set up an Emergency Action Plan (EAP) for the workplace. The EAP includes which employees are in charge in case of an emergency and emergency contact phone numbers.
  • Emergency Information
    Personalize
    Use this form to obtain an employee's contact information in case of emergency. Keep this form in the employee's personnel file.
  • Emergency Information - Spanish
    Use this form to obtain an employee's contact information in case of emergency. Keep this form in the employee's personnel file.
  • Employee Disciplinary Warning
    Use this form to record a disciplinary warning issued to an employee and the employee's acknowledgment of the warning.
  • Employee Letter - PDL Only
    Use this letter to respond to notice of an employee’s absence due to Pregnancy Disability Leave (PDL). Respond within 10 calendar days of the request or no later than the following payday, whichever is sooner. Use this letter if you are under 50 employees and not covered by the federal Family Medical Leave Act (FMLA) or if the employee seeking leave is not eligible for FMLA leave.​​​
  • Employee Orientation Checklist
    Personalize
    Have an employee complete this form as you go through the orientation process, ensuring that you cover all necessary topics and distribute all required forms. ​
  • Employee Safety Information

    ​​​Make this form available to all employees to use to report workplace safety concerns. The employee should be allowed to submit the form anonymously. Document written employee safety concerns along with any actions taken to investigate/respond. Use this form along with your Injury and Illness Prevention Program.​

  • Employer Proof of Identity and Disbursement of Final Pay - Deceased Employee
    Complete this form upon receipt of the Deceased Employee Compensation Collection Form. Place a copy of this completed form in the Decedent's file and provide a copy to the Affiant.​​​​
  • Employers Report of Occupational Injury or Illness
    Use this form to report an employee's injury or illness if it requires more than first aid. Send a copy to your insurer, or if self-insured, to the Department of Industrial Relations within five days following notice of injury or illness.
  • Employing Minors Checklist
    Use this checklist to ensure compliance when employing minors.
  • Employment Application - Long Form
    Personalize
    Use this form for new applicants. The long form includes space for more detailed information and employment history, and all other necessary sections. Remember that California prohibits employers from seeking criminal history information prior to a conditional job offer. California also prohibits employers from asking job applicants about their prior salary history. Download and read the Instructions prior to using this employment application form.

  • Employment Application - Long Form - Instructions
    Download and read these Instructions prior to using Employment Application - Long Form and Employment Application - Long Form - Spanish​.​​​
  • Employment Application - Long Form - Spanish
    Personalize
    Use this form for new applicants. The long form includes space for more detailed information and employment history, and all other necessary sections. Remember that California prohibits employers from seeking criminal history information prior to a conditional job offer. California also prohibits employers from asking job applicants about their prior salary history. Download and read the Instructions prior to using this employment application form.

  • Employment Application - Short Form
    Personalize
    Use this form for new applicants. The short form requires less employment history information.​ Remember that California prohibits employers from seeking criminal history information prior to a conditional job offer. California also prohibits employers from asking job applicants about their prior salary history.​​ Download and read the Instructions prior to using this employment application form.
    Instructions​​​​
  • Employment Application - Short Form - Instructions
    Download and read these instructions prior to using Employment Application - Short Form and Employment Application - Short Form - Spanish​.​​
  • Employment Application - Short Form - Spanish
    Personalize
    Use this form for new applicants. The short form requires less employment history information.​ Remember that California prohibits employers from seeking criminal history information prior to a conditional job offer. California also prohibits employers from asking job applicants about their prior salary history.​​ Download and read the Instructions prior to using this employment application form.
    Instructions​​​​
  • Employment Interview Checklist
    Use this sample checklist to ensure that your interview process is the same for all applicants and does not expose you to lawsuits.
  • Employment Offer Letter
    Personalize
    Use this letter to convey information to a new employee about whom they will report to, job title, starting date and time, rate of pay and classification. This letter is simply for an employee’s information and is not to be used or construed as a contract of employment. ​
  • Equal Employment Opportunity Data
    Use this form to collect information from an employee for equal opportunity employment purposes. The form is entirely voluntary for the employee and information must remain confidential and not affect application for employment.
  • Ergonomics Checklist - Computer and Keyboard Issues
    Use this checklist as an inspection tool to help you identify potential ergonomic problems related to computers and keyboards.
  • Ergonomics Checklist - Hand Tool Use
    Use this checklist as an inspection tool to help you identify potential ergonomic problems related to hand tool use.
  • Ergonomics Checklist - Manual Handling
    Use this checklist as an inspection tool to help you identify potential ergonomic problems related to manual handling.
  • Ergonomics Checklist - Task-Work Methods
    Use this checklist as an inspection tool to help you identify potential ergonomic problems related to task/work methods.
  • Ergonomics Checklist - Workstation Layout
    Use this checklist as an inspection tool to help you identify potential ergonomic problems related to workstation layout.
  • Exempt Analysis Worksheet - Administrative Exemption
    Use this worksheet to help evaluate the exempt or nonexempt status for your administrative employees.
  • Exempt Analysis Worksheet - Computer Professional Exemption
    Use this worksheet to help evaluate the exempt or nonexempt status for your computer professionals.​​
  • Exempt Analysis Worksheet - Executive Managerial Exemption
    Use this worksheet to help evaluate the exempt or nonexempt status for your managers or executives.​
  • Exempt Analysis Worksheet - Professional Exemption
    Use this worksheet to help evaluate the exempt or nonexempt status for your professional employees (such as teachers, doctors or attorneys).​
  • Exempt Analysis Worksheet - Salesperson Exemption
    Use this worksheet to help evaluate the exempt or nonexempt status for your sales staff.
  • Exit Interview
    Personalize
    Use this form to gather an employee's comments at termination regarding his or her employment with your company. Completion of the exit interview by an employee is entirely voluntary.
  • Fair Credit Reporting Act - Summary of Your Rights
    Free
    Provide a copy of this summary to the consumer (employee or applicant) before taking adverse action based on the results of a credit report. A copy of the report must accompany the summary.​​
  • Fair Credit Reporting Act - Summary of Your Rights - Spanish
    Free
    ​Provide a copy of this summary to the consumer (employee or applicant) before taking adverse action based on the results of a credit report. A copy of the report must accompany the summary.​​
  • Family Care and Medical Leave and Pregnancy Disability Leave Notice - 20 or More Employees
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with 20 or more employees (subject to the NPLA, CFRA or FMLA). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​​
  • Family Care and Medical Leave and Pregnancy Disability Leave Notice - 20 or More Employees - Spanish
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with 20 or more employees (subject to the NPLA, CFRA or FMLA). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.
  • Features of Mass Layoff and Plant Closing Laws
    Review this chart any time you are considering a layoff of a large number of employees or the temporary or permanent close or relocation of a facility or department. This chart identifies covered employers, notification requirements, penalites, trigger events, exceptions and notice content.​
  • Final Paycheck Acknowledgment
    Use this form to have an employee certify receipt of final paycheck.
  • Final Paycheck Acknowledgment - Spanish
    Use this form to have an employee certify receipt of final paycheck. Employers not fluent in Spanish should refer to the English version to complete this form properly.
  • Final Paycheck Direct Deposit Authorization
     Give this form to an employee who requests his final pay delivered by direct deposit to one or more bank accounts. Before distribution, indicate the maximum number of direct deposit accounts and financial institutions.
  • Final Paycheck Direct Deposit Authorization - Spanish
    Give this form to an employee who requests his final pay delivered by direct deposit to one or more bank accounts. Before distribution, indicate the maximum number of direct deposit accounts and financial institutions.
  • Final Paycheck Worksheet
    Personalize
    Use this form to calculate the amount of an employee’s final paycheck. It is illegal for an employer to withhold a final paycheck and failure to pay all wages due may result in penalties.
  • Fire Prevention Checklist
    Use this checklist to collect information related to fire prevention and to make sure you are taking proper measures to prevent fires in the workplace. This includes auditing those measures to ensure that they are being followed. This information should be integrated into your Fire Prevention Plan.  ​
  • Fire Prevention Plan
    Personalize
    Use this form to set up a Fire Prevention Plan (FPP) for the workplace. The FPP inlcudes which employees are in charge in case of a fire and emergency contact phone numbers for local fire departments. 
  • FMLA - Family Member Leave for a Qualifying Exigency
    This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the FMLA arising because the spouse, son, or child of the employee is on covered active duty or call to active duty.​ 
  • FMLA - Family Member Leave for a Qualifying Exigency - Spanish
    This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the FMLA arising because the spouse, son, or child of the employee is on covered active duty or call to active duty.​ ​
  • FMLA - Notice of Eligibility and Rights and Responsibilities
    Personalize
    Use this form to notify employees taking a family medical leave only regarding their eligibility for leave and any associated righ​ts and responsibilities.​ ​​
  • FMLA - Notice of Eligibility and Rights and Responsibilities - Spanish
    Personalize
    Use this form to notify employees taking a family medical only leave regarding their eligibility for leave and any associated rights and responsibilities. ​​
  • FMLA CFRA Designation Notice
    Personalize

    (Approval/Conditional Approval/Denial)

    Use this form to designate leave as FMLA/CFRA, to provide conditional approval of the request for leave if more information is necessary or to deny the request.

  • FMLA CFRA Designation Notice - Spanish
    Personalize

    Approval/Conditional Approval/Denial

    Use this form to designate leave as FMLA/CFRA, to provide conditional approval of the request for leave if more information is necessary, or to deny the request.​​​

  • FMLA CFRA Documentation Checklist for Employer Use Only
    Use this checklist to assist you in complying with all regulations regarding family medical leave and CFRA leave. ​​​
  • FMLA CFRA Policy Checklist
    This checklist will guide you through creating a Family and Medical Leave Policy. ​​​
  • FMLA PDL Designation Notice
    Personalize
    Use this form to notify an employee if her leave for PDL/FMLA is approved, conditionally approved, or denied. 
  • FMLA PDL Designation Notice - Spanish
    Personalize
    Use this form to notify an employee if her leave for PDL/FMLA is approved, conditionally approved, or denied.  ​​​
  • FMLA Sample Policy - 50 or More Employees
    Use this policy to satisfy the requirements regarding family medical leave.​
  • FMLA Sample Policy - 50 or More Employees - Spanish
    Use this policy to satisfy the requirements regarding family medical leave.​​​​​