Forms

This page links to forms used on a district wide basis.

• Employee Forms are used by individual employees to submit a request, etc.
• Administrative Forms are used to initiate a business process or task.
• Business/Accounting Forms (District Network Only).

Links to reference and/or supplemental material are provided whenever possible.

Employee Forms
​Title	​Reference
Application for Academic Degree Differential	​
​Application for Classified Degree Differential	​
​Employment Verification Request	​Tip Sheet
​Certification of Receipt of Unclassified Employee Handbook	​Unclassified Employee Handbook
​Harassment (Non-Sexual) Complaint Form R-901	​Article 3E of AFT 1521A Agreement
Expense Authorizations
CalCard Forms​
​Cardholder Statement of Questioned Item	​
​Change or Cancel Purchasing Card Account	​
​Invoice Adjustment, Notification of	​
​Missing Receipt	​
​Purchase Log	​
Approving Official Request​	​
Purchasing Cardholder Agreement	​
Request for Purchase Card​	​
​ ​Activity & Conference Forms
​Conference or Activity Attendance Request​​​	​Reimbursement Procedure
​Conference Attendance, Report on	​
​Travel Advance, Request for	​
​Out of State Student Travel, Authorization/Notification of	​
​Mileage Expense Claim​​​	​Mileage_Chart
​Travel Expense Claim​​	​
​Revolving Fund Reimbursement Request	​
​ ​Tuition Reimbursement Forms (Non-Faculty)
​Application for Tuition Reimbursement for Professional Development Report of Completion Tuition Reimbursement for Professional Activity	​
​ ​Paycheck (Salary Warrant)
​Application for Emergency Pay	​
​Warrant Recipient Designation (Beneficiary)	​
​Lost Warrant Affidavit	​
​Sabbatical Forms
​Sabbatical Leave Request - C143	​
​Sabbatical Study Plan - C147	​
​​Sabbatical Independent Study Plan - C149	​
​Sabbatical Travel Plan - C148	​
​Salary Forms (Point Credit) for Faculty - See Article 31 of AFT Agreement ​
​Application for Certificate Differential - C247	​
​Application for Point Credit Study in an Accredited College or University C153	​
​Application for Point Credit Study in the Los Angeles Community College District C970	​
​Request fo Approval of Point Credit Activity C242	​
​Application for Point Credit for Specialized Study in an Advanced School Other than an Accredited College C158	​
​Application for Point Credit for Study under Qualified Private Instructors C159	​
​Statement of Educational Travel Completed C341A	​
​Educational Travel Report C341B	​
​Petition of Completion - Educational Travel C342	​
​Proposed Itinerary for Educational Travel C684	​
​Resignation and Retirement
​LACCD Forms	​
​Employee Exit Processing	HR P-311
Resignation	​HR P-310
​Service Credit Research, CalSTRS	​
​Service Credit Research, CalPERS	​
​Retirement System Forms ​
​CalSTRS Cash Balance Benefit Program (Elect Social Security or Remain in Cash Balance)	​LACCD Letter
​CalSTRS Cash Balance - Notification & Election	​Booklet Opens link to CalSTRS
​CalSTRS Defined Benefit - Permissive Election
Requests for Change ​
Name Change Request	​
​Address and Warrant(s) Recipient Designation ("Address Change")	​Tip Sheet
​Change of Address, Classified Examinations Opens link to Personnel Commission website.	​
​Claim for Temporary Work Out of Classification Opens link to Personnel Commission website.	​
​Reinstatement (Classified Employee) Opens link to Personnel Commission website.	​
​Transfer Request (Administrator)	​
​Transfer Request (Classified Employee) Opens link to Personnel Commission website.	​
​Transfer Request (Faculty)	​
​Temporary Transfer Request (Faculty)	​
​Time Reports, Work Schedules, and Leave of Absence Forms ​
Absence Certification Request
​Unclassified Absence Certification Request	Sick Leave Eligibility Bulletin
​Annual Physical / Eye Examination Certification	​
​Catastrophic Leave Donation	​HR W-301
Faculty Absence Report Partial Day (Fractional Day)	​HR W-210
​Faculty Absence and Substitute Summary	​
​Leave of Absence Request	​Tip Sheet
​Retraining and Study Leave Request	​
​Formal Study Leave Request	​
​Independent Study Leave Request	​
​Attending Physician's Statement	​Tip Sheet
​Early Return Request	​Tip Sheet
​Overtime Request and Report	​Handbook
​Time Report: ​
​Department - Hourly Employees
TimeReport-Exception-Salaried_2020-2021.xls	​** NEW **
​​Salaried Exception 2019-20	​
​Salaried - Weekly Sign-In
​Partial Leave of Absence, Classified	​
​Voluntary Deduction Authorization Forms ​
​Charitable / Professional Organizations	​
​U.S. Savings Bond Not available at this time.	​
​Worker's Compensation ​
​Statement of Employee's Pre-Designated Physician and Employee Consent For supervisor forms, see Administrative Forms section.	​LACCD Worker's Compensation Program