Forms
This page links to forms used on a district wide basis.
Links to reference and/or supplemental material are provided whenever possible.
| 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 |
|
|---|
| Salaried Exception 2019-20 |
|
|---|
| Salaried - Exception: 2017-18 |
|
|---|
| 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 |
|---|
| Title |
Reference |
|---|
Employee Personnel File Checklists
New Hire (H-1000A)
In Service (H-1000B) |
|---|
Volunteer Forms
Application for Volunteer Services
Volunteer Report of Convictions |
R-331 |
|---|
Performance Evaluations
References refer to applicable collective bargaining agreement or link indicated below. |
|---|
Faculty, Basic and Comprehensive
Use form appropriate for assignment from collective bargaining agreement |
Appendix C
|
|---|
| Suggested Evaluation Plan Time Table & Worksheet - Comprehensive Evaluation of Tenured Faculty Member |
Page 187 |
|---|
| Suggested Evaluation Plan Time Table & Worksheet - Tenure Review |
Page 191 |
|---|
| All-Faculty - Sections A, C, and D |
Page 195 |
|---|
| Classroom Faculty - Section B |
Page 197 |
|---|
| Counselor - Section B |
Page 198 |
|---|
| Librarian - Section B |
Page 199 |
|---|
| ISA / Consulting Instruction - Section B |
Page 200 |
|---|
| College Nurse - Section B |
Page 201 |
|---|
| Disabilities Specialist / Instructor - Section B |
Page 202 |
|---|
| Child Development Center Instructor - Section B |
Page 203 |
|---|
Department Chair
CDC Director
Nursing Director |
Page 213 |
|---|
Faculty, EOP&S
DSPS Director |
Page 217 |
|---|
| Faculty Administrative Evaluations |
|
|---|
| Classroom Faculty ADMINISTRATIVE Evaluation |
Page 204 |
|---|
| Counseling Faculty ADMINISTRATIVE Evaluation |
Page 210 |
|---|
| Library Faculty ADMINISTRATIVE Evaluation |
Page 207 |
|---|
| Classified Staff Evaluations, AFT College Guild |
|
|---|
| Probationary Employee |
Article 15; Appendix B |
|---|
Permanent Employee
Prints on legal size paper. |
Article 16; Appendix C |
|---|
| Other Classified Staff Evaluations |
|
|---|
| Classified Staff, Local 99 |
Article 12 |
|---|
| Classified Staff, Building Trades |
Article 15 |
|---|
| Classified Staff, Local 721 |
Article 11 |
|---|
| Classified Staff, Confidential |
PC Rule 702 |
|---|
| Classified Staff, Management |
PC Rule 702 |
|---|
| Academic Administrator/Supervisor Evaluations |
|
|---|
| Academic Supervisor, Teamsters |
Article 8 |
|---|
| Academic Administrators / Unrepresented |
Board Rule
10105.12 |
|---|
College Presidents/Vice Chancellor
LACCD Self Assessment Instrument College President/Vice Chancellor
LACCD Data Collection College President/Vice Chancellor
LACCD Summary Evaluation of College President/Vice Chancellor |
Board Rule
10105.12
|
|---|
Academic Vice Presidents
LACCD Self Assessment Instrument College Academic Vice President
LACCD Data Collection Instrument College Academic Vice President
LACCD Summary Evaluation of College Academic Vice President |
Board Rule
10105.12 |
|---|
| Duty Statement, Academic Administrators, Teamsters |
Article 7
California Teamsters Public, Professional and Medical Employees Union, Local 911 |
|---|
Outstanding Work Performance, Notice of
Classified Employees |
|
|---|
Unsatisfactory Services, Notice of
Classified Employees |
|
|---|
| Requests |
|---|
| Academic Development Grant |
R-350 |
|---|
| Academic Staffing Request |
|
|---|
| Adjunct Provisional Equivalency |
|
|---|
| Confidential Employee Status Checklist |
H-201 |
|---|
Community Representative Assignment Request
Opens link to Personnel Commission website. |
|
|---|
Classified Staffing Request (C1121)
Opens link to Personnel Commission website. |
|
|---|
| Notification of Adjunct Faculty Selection |
HR R-130 |
|---|
Professional Expert Assignment Request
Opens link to Personnel Commission website. |
HR R-310 |
|---|
| Restricted Hiring Form |
|
|---|
| Acknowledgements and Waivers |
|---|
| 0.67 FTE Adjunct Instructor Limitation Request to Waive |
HR R-130
HR P-130 |
|---|
| Acknowledgement of Employment Conditions, Specially Funded Programs (C1117) |
|
|---|
| Employee Affidavit (W-11) |
|
|---|
| 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, AdminSure |
Reporting Occupational Injuries and Illnesses |
|---|
| Incident / Injury Report, LACCD |
|
|---|
| Referral for Treatment of Occupational Injury or Illness |
|
|---|
| Supervisor's Report of Employee Injury or Illness, LACCD |
|
|---|