Documents for Faculty & Staff

This is a multi-user, campus-wide, searchable database for forms, schedules, handbooks and any other documents of general interest for faculty and staff members. Search results will list each item by title, category, description, date and document type (PDF, Word, Excel, or Online).

To find professional development opportunities and resources please visit the SCC Professional Development Database.

If you need access to this database to post your documents, contact Jarom Burbano.


 

  • Human Resources Docs

    • ADA/FEHA Accommodation Request
      03/2014
      Form
      ADA/FEHA Accommodation Request
    • APPLICATION FOR CREDIT FOR SALARY SCHEDULE ADVANCEMENT FOR LOWER DIVISION UNITS AND NON-ACADEMIC ACTIVITIES
      08/2014
      Form
      LRCCD APPLICATION FOR CREDIT FOR SALARY SCHEDULE ADVANCEMENT FOR LOWER DIVISION UNITS AND NON-ACADEMIC ACTIVITIES
    • Catastrophic Illness or Injury Leave Classified and Management Employees Application
      10/2008
      Form
      BS #185: The purpose of the Catastrophic Illness or Injury Leave Program is to establish a program where employees may donate eligible leave credits to a Catastrophic Illness or Injury Leave Bank that may be used by an eligible employee when that employee or a member of his or her immediate family suffers from a catastrophic illness or injury.
    • Catastrophic Sick Leave - Extended Paid Leave Application
      Form
      LRCCD Application for the Extended Paid Catastrophic Sick Leave. Go to http://www.losrios.edu/legal/Regulations/R-9000/R-9239.htm for the LRCCD regulation describing this benefit. [Must print to use]
    • College Service Activities form
      12/2014
      Document
      College Service should average 5 hours per regular work week is directed and schedule by the individual faculty member, and the allotted time may vary according over the semester/fiscal year. LRCFT Contract article 4.1.3: College Service represents a professional obligation by a full-time faculty to the institution. Participation, to be determined by the faculty member, may include, but not be limited to the following activities: advisory committees, college planning processes, compliance related training such as sexual harassment prevention and information security. Note: This document is hosted on the Lost Rios District website. It can only be opened on campus.
    • Delta Dental - Enrollment/Change
      Document
    • Delta Dental Enrollment - Non Voluntary
      05/2005
      Document
      Delta 6028
    • Dental Insurance Cancellation Request
      04/2012
      Form
      BS#208
    • Designation of Beneficiary Request
      Form
    • Email Access Request Form - Temporary Classified / Student Employees
      02/2014
      Form
      The Temporary Classified (TCL)/Student Employees Email Access Request Form must be completed for each college TCL/Student employee who requires a Los Rios Community College email account.
    • Employment Eligibility Disclosure Form
      08/2011
      Form
      P-150 Student Help, Federal Work Study, Temporary Classified, Employment Service Agreement - Hiring packet.
    • Employment Service Agreement (ESA) - Academic P-132-A - On or after July 1, 2016
      07/2016
      Document
      Los Rios Community College District form: Employment Service Agreement (ESA) P-132-A active July 1, 2016. Employment Service Agreements (ESAs) are used to compensate employees for certain types of academic (instructional) assignments that are not part of their regular load, adjunct, or overload work. ***6/17/2016 SPECIAL NOTE: Use ESA Form 132-91 for ESAs with start date prior to July 1, 2016. Use new ESA form P-132-A for ESAs with start date on or after July 1, 2016.
    • Employment Service Agreement (ESA) REVISION Form - Academic P-132-A(R)
      07/2016
      Document
      Los Rios Community College District form: Employment Service Agreement (ESA) REVISION Form - Academic P-132-A(R) active July 1, 2016. Complete this form when making revisions to an existing ESA. Attach a copy of the original ESA or the most recent ESA revision so that Human Resources can reference the specific changes being made. If correcting errors (i.e. position number, retirement question, etc.) please do not submit a revision; instead, correct the original ESA by crossing out the incorrect information and entering the new information. The initiating/approving administrator(s) must initial next to these changes. A copy of the revised ESA must be provided to the employee.
    • Employment Service Agreement - Required Forms List
      Document
      ESAs are used to compensate certificated (academic) employees for certain types of assignments that are not part of regular load or adjunct and overload service.
    • Enrollment/ Change Form - California Region Group
      10/2011
      Form
      79829
    • Equivalency Verification
      Form
      This application requires evaluation for equivalency before screening and interviewing. Please use this form (P-38) for the equivalency process. For the composition and the procedure for the formation of the Equivalency Committee, refer to Los Rios Community College Administrative Policy/Regulation (R-5123, Sections 8.0 and 9.0. Form P-38).
    • Evaluation Form/Performance review/Job performance Form
      Document
      This web page contains links to all constituency EvaluationForm/Performancereview/Job performance Form.
    • Evaluation Forms
      03/2014
      Form
      Evaluation Forms: Classified, Management, Supervisor, and Faculty.
    • Exclusion from CalPERS Membership Notice - Student Help
      03/2008
      Form
      PERS-AESD-139
    • Exclusion from CalPers Membership Notice - Temporary Classified
      Form
      PERS FORM AESD-139 [Must download to fill in, then print]
    • Family Medical Leave - Certification of Physician or Practitioner
      Document
    • FDIP employee personal and emergency information form - New
      Form
    • Hartford - Benefits Enrollment Form 10-month Employee
      01/2011
      Form
      LRCCD Generic Enrollment Form [Must download/save, then print]
    • Hartford - Benefits Enrollment Form 12-month Employee
      01/2011
      Form
      Los Rios Community College District Generic
    • Health Insurance Certification
      06/2004
      Form
      GS Form #114
    • Inclusion of Sierra College FTE [Adjunct Faculty] Request
      05/2004
      Form
      CCFS-361 GS Form #51
    • Interest Form for Adjunct Faculty Office Hours Program
      01/2012
      Form
    • Interest form for Adjunct Faculty Office Hours Program Fall & Spring
      08/2007
      Form
    • Management Evaluation
      08/2012
      Form
      P-200
    • Mandated Reporter - Statement
      01/2013
      Form
      P-155
    • Name / Address Change - Employee
      06/2015
      Form
      P-113
    • Nonresident Reduced Withholding 587
      Form
      For Privacy Notice, get form FTB 1131.
    • Nonresident Reduced Withholding 588
      Form
    • Nonresident Reduced Withholding 589
      Form
      For Privacy Notice, get FTB 1131 ENG/SP
    • Out of Classification Pay Request/Authorization Temporary Reclassification - Employee
      08/2002
      Form
      P103E
    • PARS ARS 457 Plan Distribution Application
      06/2008
      Form
      The PARS Alternate Retirement System Plan was created to comply with federal legislation called the Omnibus Budget Reconciliation Act of 1990 (OBRA 90). This legislation required that part-time, seasonal, and temporary employees participate in Social Security or an alternative plan established according to IRS guidelines. The PARS Alternate Retirement System 457 Plan (PARS ARS 457 Plan) is an alternate to Social Security. The deductions for the PARS ARS 457 Plan are withdrawn from your paycheck in lieu of deductions for Social Security.
    • Performance Review - Athletic Coach Faculty
      04/2005
      Form
      [Triplicate form = WHITE-Human Resources, YELLOW-Administrator, GOLD-Reviewing Administrator]
    • Performance Review - Classroom Faculty
      04/2008
      Form
      [Must download/save then print to use; Triplicate = WHITE-Human Resources, YELLOW-Administrator, PINK-Employee, GOLD-Reviewing Administrator]
    • Performance Review - Coordinator
      04/2005
      Form
      [Must download/save then print to use; Triplicate = WHITE-Human Resources, YELLOW-Administrator, PINK-Employee, GOLD-Reviewing Administrator]
    • Performance Review - Narrative Comments
      04/2006
      Form
      Faculty performance review process.
    • Performance Review - Nurse
      04/2006
      Form
    • Physician's Verification of Injury/Illness Form
      Form
    • Political Dos and Don'ts
      03/2016
      Document
    • Professional Expert Agreement (PEX) P-132-P
      07/2016
      Document
      Los Rios Community College District form: Professional Expert Agreement (PEX) P-132-P active July 1, 2016. Professional Expert Agreements (PEXs) are used for non-academic services wherein professional expertise and/or specialized knowledge are required. Professional Experts are to be hired on a short-term, temporary basis for a specific project (Education Code 88003). Professional Experts are not part of the classified service; therefore, the services rendered on a PEX cannot be found within an existing LRCCD job description. For revisions use PEX Revision Form P-132-P(R).
    • Professional Expert Agreement (PEX) REVISION Form P-132-P(R)
      07/2016
      Document
      Los Rios Community College District form: Professional Expert Agreement (PEX) REVISION P-132-P(R) active July 1, 2016. Complete this form when making revisions to an existing PEX. Attach a copy of the original PEX or the most recent PEX revision so that Human Resources can reference the specific changes being made. If correcting errors (i.e. position number, retirement question, etc.) please do not submit a revision; instead, please correct the original PEX by crossing out the incorrect information and entering the new information. The initiating/approving administrator(s) must initial next to these changes. A copy of the revised PEX must be provided to the employee.
    • Release of Medical Information Authorization
      Form
    • Request for Reclassification (Classified)
      03/2014
      Form
      Request for Reclassification. (Classified)
    • Resignation/ Retirement
      03/2013
      Form
      P104
    • Retiree Processing form
      02/2008
      Form
    • Retiree Transfer of Funds Authorization
      Form
    • Retirement Plan Participation Information Form - CalSTRS
      Form
      The information requested on this form will be used to determine if wages should be subject to Social Security/Medicare withholding or withholding for Medicare and the California State Teachers’ Retirement System (CalSTRS).
    • Salary Reduction Agreement - SRA (Entire Packet) (403(b) TSA, 457(b) DCP Envoy Service Plan
      Form
    • Taxpayer Identification Number and Certification (W-9) Request Form
      08/2013
      Form
      Purpose of Form: A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Form W-9
    • Temporary Classified Hiring Forms List
      Document
      Listed on this webpage are links to all forms which must accompany each "Intent to Employ" for NEW Temporary Classified Employee's.
    • Temporary Employee Compliance Checklist Temporary Classified, Student Help, Federal Work Study or ESA (Employee Service Agreement)
      Form
    • Termination of Domestic Partnership - Statement
      Form
    • Transaction Request Form - Envoy Plan Services
      07/2009
      Form
      • All transaction requests must be submitted to Envoy Plan Services for review and certification on behalf of your Employer. • A Transaction Request Form must be completed and accompany all transaction requests submitted to Envoy Plan Services. • The Transaction Request Form is located on the Envoy Plan Services website at www.envoyplanservices.com. • Transaction requests include: Loans Distributions - Separation from service - Age 59 ½ ? - Required minimum distribution (RMD) Rollovers 403(b) Hardship Withdrawals 457(b) Unforeseen Emergency Contract Exchanges Transfers Qualified Domestic Relations Order (QDRO)
    • Travel Authorization and Reimbursement Claim
      Form
    • UNUM Checklist
      Form
      7600-04. Form for voluntary Group Long Term Care Insurance coverage to all active fulltime employees working a minimum of 20 hours per week.
    • UNUM Class 002 Certificated Employees Benefit Election Form
      Form
      GLTC04-EF001-VOL; Form for voluntary Group Long Term Care Insurance coverage to all active certificated employees working a minimum of 50%.
    • UNUM Enrollment Form
      Form
      GLTC04-EF001-VOL; Form for voluntary Group Long Term Care Insurance coverage to all active fulltime employees working a minimum of 20 hours per week.
    • UNUM Group Long Term Care
      02/2010
      Form
      1116-01; Form for voluntary Group Long Term Care Insurance coverage to all active fulltime employees working a minimum of 20 hours per week.
    • Vacation Balance Disposition Request
      04/2013
      Form
      BS #64
    • Vendor Application Packet
      06/2013
      Form
    • Vision Services Plan - VSP Enrollment
      02/2014
      Form
      BS Form #160/4/2012
    • Waiver/Assumption of Risk and Agreement to Participate - Employee
      07/2013
      Form
      GS 14: This is a release of liability and assumption of risk agreement while participating in an LRCCD activity that can involve risk or injury,