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CA CalHR 695 2021-2025 free printable template

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Clear Form New Enrollment State of California - Department of Human Resources RETIREE VISION PLAN ENROLLMENT AUTHORIZATION CalHR 695 Rev 6/20/2012 Page 1 Please type or use ballpoint pen print clearly - send completed forms to vision plan vendor. I hereby certify under penalty of perjury as follows That I am the duly appointed qualified and acting officer of the herein named agency and that I am authorized to make this the duly appointed qualifie...
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CA CalHR 695 Form Versions

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CA CalHR 695 2021
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How to fill out CA CalHR 695

01
Begin by downloading the CA CalHR 695 form from the CalHR website.
02
Fill out your personal information at the top of the form, including your name, address, and contact information.
03
Complete the 'Position Information' section by providing details about your current job title and department.
04
In the 'Leave of Absence' section, indicate the type of leave you are requesting and the dates of the leave.
05
Review the 'Reason for Leave' section and provide a clear, concise explanation for your request.
06
If required, attach any supporting documentation that verifies your need for leave.
07
Read and sign the certification statement confirming that the information provided is true and accurate.
08
Submit the completed form to your immediate supervisor or the appropriate HR representative.

Who needs CA CalHR 695?

01
Employees of California state agencies who are requesting a leave of absence.
02
Employees seeking to formalize their request for time off due to personal, medical, or family-related reasons.
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CA CalHR 695 is a form used by the State of California Human Resources Department (CalHR) to report and disclose financial interests to avoid conflicts of interest for certain employees and officials.
Individuals in designated positions, which typically includes upper management and officials with decision-making authority, are required to file CA CalHR 695.
To fill out CA CalHR 695, individuals must provide personal information, details about their financial interests, including income sources, investments, and property, and sign the form to attest its accuracy.
The purpose of CA CalHR 695 is to ensure transparency and accountability in government by disclosing potential conflicts of interest that may affect the integrity of decision-making processes.
The form requires reporting information such as personal income, business interests, real estate holdings, investments, and any gifts received, to assess the potential for conflicts of interest.
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CalHR 695. Page 1 of 2. Retiree Vision Plan Enrollment. California Department of Human Resources. State of California. Send Completed Form to:.
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