This page links to forms used on a districtwide
basis.
Links to reference and/or supplemental material are provided whenever possible.
Reference |
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Employment Verification Request  |
Tip Sheet |
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| Expense Authorizations |
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CalCard Forms |
Cardholder Statement of Questioned Item  |
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Change or Cancel Purchasing Card Account |
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Invoice Adjustment, Notification of  |
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Missing Receipt  |
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Purchase Log  |
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| Conference Forms |
| Conference or Activity Attendance Request 
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Reimbursement Procedure |
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Conference Attendance, Report on  |
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Travel Advance, Request for  |
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Mileage Expense Claim  |
Mileage_Chart |
Updated! |
Travel Expense Claim  |
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Updated! |
Revolving Fund Reimbursement Request  |
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| Paycheck (Salary Warrant) |
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Application for Emergency Pay  |
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Direct Deposit Authorization  |
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Warrant Recipient Designation (Beneficiary)  |
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Lost Warrant Affidavit  |
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| Resignation and Retirement |
| |
LACCD Forms |
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Resignation  |
HR P-310
Tip Sheet |
Application for Retiree Health Benefits  |
Tip Sheet |
Employee Exit Processing  |
HR P-311 |
Service Credit Research, CalSTRS  |
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Service Credit Research, CalPERS  |
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| Retirement System Forms |
CalSTRS Cash Balance Benefit Program 
|
LACCD Letter |
CalSTRS Cash Balance - Notification & Election  |
Booklet
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CalSTRS Defined Benefit - Permissive Election  |
| Requests for Change |
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Address and Warrant(s) Recipient Designation 
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Change of Address, Classified Examinations
Opens link to Personnel Commission website. |
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Claim for Temporary Work Out of Classification
Opens link to Personnel Commission website. |
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Reinstatement (Classified Employee)
Opens link to Personnel Commission website. |
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Transfer Request (Classified Employee)
Opens link to Personnel Commission website. |
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| Time Reports, Work Schedules, and Leave of Absence Forms |
| |
Absence Certification/Request |
Tip Sheet |
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Annual Physical / Eye Examination Certification  |
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Catastrophic Leave Donation  |
HR W-301 |
Faculty Absence Report, Partial Day (Fractional Day)  |
HR W-210 |
Faculty Absence and Substitute Summary  |
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Leave of Absence Request  |
Tip Sheet |
| |
Attending Physician's Statement  |
Tip Sheet |
Early Return Request  |
Tip Sheet |
Overtime Request and Report |
Handbook |
| Time Report: |
| |
Department - Hourly Employees  |
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Salaried - Exception: 2008-09 |
Handbook |
Salaried - Weekly Sign-In  |
Handbook |
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Work Schedule: D / G Basis Employees  |
HR W-410 |
| Voluntary Deduction Authorization Forms |
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Charitable / Professional Organizations  |
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Salary Deduction Agreement / TSA  |
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Termination of Agreement / TSA  |
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U.S. Savings Bond
Not available at this time. |
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| Worker's Compensation |
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Statement of Employee's Pre-Designated Physician and Employee Consent 
For supervisor forms, see Administrative Forms section. |
LACCD Worker's Compensation Program |
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| Administrative Forms |
Title |
Reference |
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| Performance Evaluations
References refer to applicable collective bargaining agreement or link indicated below.
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| |
Faculty, Basic and Comprehensive
Copy form appropriate for assignment from collective bargaining agreement
|
Article 19
Article 42
Appendix C |
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| All-Faculty - Sections A, C, and D |
Page 180 |
| Classroom Faculty - Section B |
Page 182 |
| Counselor - Section B |
Page 183 |
| Librarian - Section B |
Page 184 |
| ISA / Consulting Instruction - Section B |
Page 185 |
| College Nurse - Section B |
Page 186 |
| Disabilities Specialist / Instructor |
Page 187 |
| Child Development Center Instructor |
Page 188 |
| Administrative Evaluation Classroom Faculty |
Page 189 |
| Department Chair
CDC Director
Nursing Director |
Page 192 |
| Faculty, EOP&S
DSPS Director
|
Page 196 |
| Classified Staff, AFT College Guild |
Article 16 |
Probationary Employee
Contact Personnel Commission |
Page 31 |
Permanent Employee
Prints on legal size paper. |
Page 31 |
Classified Staff, Local 99  |
Article 12 |
Classified Staff, Building Trades  |
Article 15 |
Classified Staff, Local 347  |
Article 11 |
Classified Staff, Confidential  |
PC Rule 702 |
Classified Staff, Management  |
PC Rule 702 |
Academic Administrators, Teamsters  |
Article 8 |
Academic Administrators, Unrepresented  |
Board Rule
101005.12 |
College Vice Presidents  |
Board Rule 101005.12
PC Rule 702 |
New! |
Outstanding Work Performance, Notice of 
Classified Employees |
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| Requests |
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Academic Development Grant  |
R-350 |
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Adjunct Provisional Equivalency  |
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Classified Staffing Request (C1121)
Opens link to Personnel Commission website. |
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Community Representative
Opens link to Personnel Commission website. |
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Confidential Employee Status Checklist  |
H-201 |
Professional Expert
Opens link to Personnel Commission website. |
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| Waivers |
| |
0.6 FTE Adjunct Instructor Limitation Contract Provision  |
HR R-130
HR P-130 |
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Instructor, Special Assignment / Consulting Instructor
Contract Provision |
HR R-121 |
PACE Contract Provision  |
HR R-124 |
| Worker's Compensation |
| |
Employer's Report of Occupational Injury or Illness, Southern California Risk Management Associates, Inc.  |
Reporting Occupational Injuries and Illnesses |
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Incident / Injury Report, LACCD  |
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Referral for Treatment of Occupational Injury or Illness |
Supervisor's Report of Employee Injury or Illness, LACCD  |
Worker's Compensation Claim Form & Notice of Potential Eligibility, State of California  |
LACCD Worker's Compensation Program |