About DTSC

We are determined to safeguard California from the harmful effects of chemicals

DTSC Personnel Documents

* For DTSC New to State Hires Only *

As part of the hiring process, you will need to read and sign a number of documents. There are three sections of documents, each with a due date when forms must be submitted by. Guides are available that will walk you through filling out each form. Be sure to open the guides and follow along as you complete each form.

You will be contacted by a Personnel Liaison to go over these documents within 24-48 hours of your offer letter.

Part I: Prior to Start Date

Required Documents: Return to Human Resources (HR) (must be returned to HR on employees first day)

Electronically sign and print to PDF the below documents:

Employment Eligibility Verification (Form I-9) (Complete Page 1 and submit to HR)
- I-9 Employee Information Sheet (M-1116) (For your information only)
- I-9 Supporting Documentation (Show the original documents and submit a copy to HR)
Employee Action Request (EAR 686)
- Guide to fill out Employee Action Request form
Nondisclosure of Employee Home Address (STD 677)
Emergency Notification Form (DTSC 1224)
Oath of Allegiance (STD 689)

Part II: On your first day

Electronically sign and print to PDF the below documents:

Designation of Person Authorized to Receive Warrants (STD 243)
State Employee Race/Ethnicity Questionnaire (CalHR 1070)
Workplace Guidelines and Expectations (Read)
Workplace Guidelines Acknowledgment of Policies (Follow each link, read the policy, complete the form, and submit to HR)
Daily Log Electronic Signature Agreement (DTSC)
Wounded Warrior Acknowledgment (DTSC 1609)
Medical Provider Network (MPN e3841)
New Employees Guide to Workers Comp (E13546) (Read)
Military Declaration (STD 912)
Member Reciprocal Self Certification (CalPERS-1187) (Complete and submit to HR within 10 business days)
CalPers Retirement Benefit Election Package (Optional, complete page 4 and submit to HR)
Beneficiary Designation (CalPERS 0772) (Complete and submit to HR)
Annual Leave-Sick/Vacation Election Form (CalHr 875)
- Vacation vs. Annual Comparison Chart
- Disability information on Annual Leave program for employees who are Exempt, Managers, Supervisors & employees
  in bargaining units 2, 7, 9, and 10
- Non-Industrial Disability Insurance

Part III: Optional Benefits

Must be returned to HR within 60 days of effective date of hire

2024 Consolidated Benefits Handbook (Exempt and BU 2, 7, 8, 16,17 18 & 19 only)
2024 Health Benefits Summary Handbook
- CalPERS Health Plans
- Health Enrollment Form (Pers-HBD-12)
- Dependent Eligibility Verification Checklist (CalHR 781) (Complete and submit to HR if adding dependents)
2024 Dental Handbook (read)
- Dental Enrollment Form (STD 692) (Read, complete, and submit to HR)
- Dental 24-month restriction ( New to State Employee)
  - All eligible newly hired represented employees in Bargaining Units 1 through 21, (except Units 2, 7, 8, 16, 17, 18, 19, and excluded employees), are required to select their dental plan coverage from one of the four available state-sponsored prepaid dental plans. Impacted employees may select only a prepaid plan until they have completed 24 months of employment without a permanent break during the 24-month qualifying period. At the end of the 24-month period, those employees that elected a prepaid plan will have 60 days to change their enrollment to Delta PPO plus Premier or Delta PPO. Those employees that chose not to enroll in a prepaid dental plan may elect Delta Dental, within 60 days after completing the restriction period, unless they enrolled in the FlexElect cash option for dental.
  - All eligible newly hired represented employees in Bargaining Units 2, 7, 8, 16, 17, 18, 19, and excluded employees (non-represented) may elect Delta PPO plus Premier or PPO at the time of hire and are not restricted to state-sponsored prepaid plans
VSP Basic/Premier Plan
- Vision Member Benefit Summary
- Basic Vision Plan -The state’s basic vision plan is part of the VSP Advantage network and is an automatic
  
  benefit, provided by the State of California for eligible state employees and their dependents.
- Premier Vision Enrollment Form (CalHR 774)
Flex Cash (STD 701C)
Flex Reimbursement Account (STD 701R)
- Flex Program link
Benefits Calculator (used to calculate out of pocket cost)