Faculty & Staff Resources Forms

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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 |
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Purchasing Cardholder Agreement |
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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 |
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Sabbatical Independent Study Plan - C149 |
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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 |
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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 |
|
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 |
|
Time Exception Salaried Form 2021-22 |
|
Time Exception Salaried Form 2020-21
|
|
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-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 |
|
Classified Employees |
|
Classified Employees |
|
Evaluation Alert System (EASY) |
Evaluation Alert System (EASY) Operation & User Manual
|
Requests |
Academic Development Grant |
R-350 |
Academic Staffing Request |
|
Adjunct Provisional Equivalency |
|
Confidential Employee Status Checklist |
H-201 |
Opens link to Personnel Commission website. |
|
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 |
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
|
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 |
|
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