Turn on more accessible mode Turn off more accessible mode Skip Ribbon Commands Skip to main content
Navigate Up
This page location is:
LACCD > Faculty and Staff > Forms
Help (new window)
Sign In

LACCD Logo

Los Angeles Community College District

Search
  • LACCD
    • HOME
    • ABOUT LACCD
    • BOARD OF TRUSTEES
    • STUDENTS
    • FACULTY AND STAFFCurrently selected
    • BUSINESS AND COMMUNITY
    • EMPLOYMENT
LACCD > Faculty and Staff > Forms

Faculty & Staff Resources Forms

  • Faculty and Staff
Page Image
Page Content
 

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.xlsTimeReport-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
 
​Administrative Forms ​

​Title ​Reference

Employee Personnel File Checklists
    New Hire (H-1000A)
    In Service (H-1000B)

Intern Forms
   Intern Application
   Intern Report of Convictions

 Volunteer-Intern Process Instruct.​

Volunteer Forms

     Application for Volunteer Services

     Volunteer Report of Convictions

 

   ​​HR R-331​​

   Volunteer-Intern Process Instruct.

​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.
​
General Equipment and/or Non-Consumable Supplies On Loan Form ​
Technology Equipment On Loan Form ​
​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 ​
Worker's Compensation Claim Form & Notice of Potential Eligibility, State of California LACCD Worker's Compensation Program
​​​
​​​S​

Los Angeles Community College District