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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Harassment (Non-Sexual) Complaint Form R-901 |
Article 3E of AFT 1521A Agreement |
New! |
| 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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| Activity & Conference Forms |
| Conference or Activity Attendance Request |
Reimbursement Procedure |
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| Conference Attendance, Report on |
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| Travel Advance, Request for |
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| Out of State Student Travel, Authorization/Notification of |
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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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| Warrant Recipient Designation (Beneficiary) |
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| Lost Warrant Affidavit |
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| Salary Forms (Point Credit) for Faculty - See Article 31 of AFT Agreement |
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Application for Certificate Differential - C247 |
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| Application for Point Credit Study in an Accredited College or University C153 |
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| Application for Point Credit Study in the Los Angeles Community College District C970 |
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Request fo Approval of Point Credit Activity C242 |
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Application for Point Credit for Specialized Study in an Advanced School Other than an Accredited College C158 |
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Application for Point Credit for Study under Qualified Private Instructors C159 |
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Statement of Educational Travel Completed C341A |
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Educational Travel Report C341B |
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Petition of Completion - Educational Travel C342 |
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Proposed Itenerary for Educational Travel C684 |
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| Resignation and Retirement |
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LACCD Forms |
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| Resignation |
HR P-310
Tip Sheet |
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| Application for Retiree Health Benefits |
Tip Sheet |
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| Employee Exit Processing |
HR P-311 |
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| Service Credit Research, CalSTRS |
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| Service Credit Research, CalPERS |
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| Retirement System Forms |
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CalSTRS Cash Balance Benefit Program
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LACCD Letter |
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| CalSTRS Cash Balance - Notification & Election |
Booklet
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| CalSTRS Defined Benefit - Permissive Election |
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| Requests for Change |
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Address and Warrant(s) Recipient Designation
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Tip Sheet |
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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 |
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Absence Certification/Request  |
Tip Sheet |
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| Annual Physical / Eye Examination Certification |
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| Catastrophic Leave Donation |
HR W-301 |
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| Faculty Absence Report, Partial Day (Fractional Day) |
HR W-210 |
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| Faculty Absence and Substitute Summary |
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| Leave of Absence Request |
Tip Sheet |
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Attending Physician's Statement |
Tip Sheet |
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| Early Return Request |
Tip Sheet |
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Overtime Request and Report  |
Handbook |
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| Time Report: |
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Department - Hourly Employees  |
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| Salaried - Exception: 2009-10 |
Handbook |
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Salaried - Weekly Sign-In |
Handbook |
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Work Schedule: D / G Basis Employees |
HR W-410 |
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| Voluntary Deduction Authorization Forms |
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Charitable / Professional Organizations |
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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 |
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| Classroom Faculty - Section B |
Page 182 |
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| Counselor - Section B |
Page 183 |
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| Librarian - Section B |
Page 189 |
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| ISA / Consulting Instruction - Section B |
Page 185 |
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| College Nurse - Section B |
Page 191 |
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| Disabilities Specialist / Instructor |
Page 192 |
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| Child Development Center Instructor |
Page 193 |
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| Administrative Evaluation Classroom Faculty |
Page 194 |
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| Department Chair
CDC Director
Nursing Director |
Page 197 |
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| Faculty, EOP&S
DSPS Director |
Page 197 |
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| Classified Staff, AFT College Guild |
Article 16 |
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Probationary Employee
Contact Personnel Commission |
Page 31 |
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Permanent Employee
Prints on legal size paper. |
Page 31 |
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| Classified Staff, Local 99 |
Article 12 |
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| Classified Staff, Building Trades |
Article 15 |
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| Classified Staff, Local 721 |
Article 11 |
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| Classified Staff, Confidential |
PC Rule 702 |
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| Classified Staff, Management |
PC Rule 702 |
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| Academic Administrators, Teamsters |
Article 8 |
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| Academic Administrators, Unrepresented |
Board Rule
101005.12 |
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| College Vice Presidents |
Board Rule 101005.12
PC Rule 702 |
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Outstanding Work Performance, Notice of
Classified Employees |
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Unsatisfactory Services, 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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| Confidential Employee Status Checklist |
H-201 |
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Community Representative Assignment Request
Opens link to Personnel Commission website. |
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Classified Staffing Request (C1121)
Opens link to Personnel Commission website. |
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| Notification of Adjunct Faculty Selection |
HR R-130 |
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Professional Expert Assignment Request
Opens link to Personnel Commission website. |
HR R-310 |
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Restricted Hiring Form |
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| Acknowledgements and Waivers |
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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 |
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| PACE Contract Provision |
HR R-124 |
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Acknowledgement of Employment Conditions, Specially Funded Programs (C1117) |
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New! |
| Worker's Compensation |
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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 |
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| Supervisor's Report of Employee Injury or Illness, LACCD |
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| Worker's Compensation Claim Form & Notice of Potential Eligibility, State of California |
LACCD Worker's Compensation Program |
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