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Payroll Services Forms

Form

Description

Campus

Damage Payments

   

Damage Payment Report of Services Performed Before Signing Loyalty Oath (PDF)

  UC Davis

Loyalty Oath—Damage Payment Release (PDF)

  UC Davis

Special Handling of Payroll

   
Advance Check Request (PDF)   UC Davis
Declaration of Lost or Destroyed UCD Check (PDF)   UC Davis
Declaration of Lost or Destroyed UCD Payroll Vendor Check (PDF)   UC Davis
Emergency Payroll Advance Request (PDF) For employees to request an advance on their earnings for any personal emergency reasons.
Submit to: Workers Compensation
UC Davis Health

Online Earnings Statement Exception (PDF)

Complete if you are requesting to receive a paper Direct Deposit Earnings Statement or you are cancelling a previous request for a paper Direct Deposit Statement and now want to view your statement online.
Submit to: Payroll Services Office, or fax to 530-757-8597

UC Davis / UC Davis Health
Payroll Address Change (PDF) Allows employees to notify of an address change to receive paychecks and statements.
Submit to: UC Davis Health Payroll
UC Davis Health
Payroll Checks through the Mail (PDF) Complete to request your payroll checks to be delivered through the mail.
Submit to: UC Davis Health Payroll
UC Davis Health
Separation Check Request (PDF)   UC Davis

UPAY 564-3 - One-Time Payroll Payment Authorization (PDF)

  UC Davis
UPAY 644D - Payroll Time Reporting Adjustment Worksheet (XLS)   UC Davis

Transfer of Payroll

   
Dept Pre-Approval Form: Transfer of Salary Expense (Extramural Fund Source)  (PDF)   UC Davis

Salary Expense Transfer Access Application (PDF)

  UC Davis
UPAY 560-T - Temporary Interlocation Transfer or Multilocation Appointment (PDF)   UC Davis
UPAY 644C-T - Interlocation One-Time Payment (PDF)   UC Davis

Employment Forms

   

Direct Deposit Election (PDF)

Allows new and rehires to provide banking information for e-direct deposits.
Submit to: Shared Services Organization, Recruitment Coordinators
UC Davis Health
I-9 - Employment Eligibility Verification (PDF) Instructions for I-9 (PDF) UC Davis
Payroll Transmittal Form (PDF)   UC Davis
Self Identification of Disability (PDF)   UC Davis
Self Identification of Ethnicity/Veteran Status (PDF) Guidelines (PDF) UC Davis

Statement of Citizenship (PDF)

  UC Davis
UPAY 1 - Pay Disposition Form (PDF)   UC Davis / UC Davis Health
UPAY 544 Personal Data Form (PDF) Provide necessary employment information for payroll and personnel matters.
Submit to: UCOP Payroll
UC Davis / UC Davis Health
UPAY544A Personal Data Form for Union Workers (PDF) Union workers provide necessary employment information for payroll and personnel matters.
Submit to: UCOP Payroll
UC Davis / UC Davis Health
UPAY 585 - State Oath of Allegiance, Patent Policy, and Patent Acknowledgment (PDF)   UC Davis / UC Davis Health
Verification of Previous Employment (PDF)

Complete this form to request verification of previous UC, CSU, or State of CA employment.
Submit to: Payroll

UC Davis
W4 - Employee's Withholding Allowance Certificate (PDF) Used by employers to determine the correct amount of tax withholding to deduct from employees' wages.
Submit to: Payroll
UC Davis / UC Davis Health
W-4 (Non-Resident Alien) - Employee's Federal-State Withholding Allowance Certificate (PDF)   UC Davis / UC Davis Health

PPS & PPS DS Application

   
Add/Change Home Department Code (Webform)    
PPS/OPTRS Access/Change Application (PDF) Instructions (PDF) UC Davis
PPS-DS Access/Change Application (PDF)   UC Davis
Request Review of Exercises (Webform)   UC Davis

PAN Review

   
Checklist for Departmental PAN Review (PDF)    
Checklist for Central Office PAN Review (PDF)   UC Davis

Dept Roles Structure System

   

Checklist to Check Status of Structure in DRS System (PDF)

  UC Davis

Checklist to Update Structure in DRS System (PDF)

  UC Davis

Checklist to Add/Change PPS Officer in DRS System (PDF)

  UC Davis
Central Office OPTRS Org Structure (PDF)   UC Davis
Central Office PPS Org Structure (PDF)   UC Davis