Forms

Pre-Employment

• Employee Referral Form
  Enter a drawing to be rewarded for inviting talented people to work at L&C.
• Faculty Background Check Authorization
  Final Candidates Only
• Staff Background Check Authorization
  Final Candidates Only
• Summary of Fair Credit Reporting Act
  Understand your rights
• List of Appropriate Documents for the I-9
  What to bring on your first day.
• Staff Handbook
  To acquaint you with the College’s policies, procedures, and practices.
  Not every policy or practice of the College is contained in this Handbook.

Contact Info

• Would you like to update your address?
  Please complete our online form. Please note, if you are a current LC student, please contact the Registrar’s Office regarding updating your address.
• Personal Information Sheet
  For new employees who wish to provide their contact information
  

Payroll

• Faculty/Staff Direct Deposit Enrollment
  Sign up for direct deposit and electronic statements.
• Student Direct Deposit Enrollment
• Sign up for electronic pay advices.
• Opt Out Form
   Submit to opt out of receiving paperless advices

• FAQ Paperless Advices
  Find out more about paperless advices
• Form W-4
• Designate your tax withholdings.
• Time Sheet Template 2013-2014 (Hourly)                                               Record your regular hours, vacation, and sick pay starting June 16, 2013.
  
• Time Sheet Template 2012-2013 (Hourly)                                                       Record your regular hours, vacation, and sick pay starting June 18, 2012.

• Exempt Employee Absence Report (Salaried)
  Record your vacation and sick days.

• W-2 Duplicate Request Form
  Submit this form to receive a duplicate W-2
  
• Pay Statement Replacement Form
  To request a duplicate pay statement or advice.
• Lost, Stolen or Damaged Payroll Check Replacement Request Form       

Accommodations

• Reasonable Accommodation Request
  Assist the College in making reasonable accommodations.
• Disability Verification
  Determine your eligibility for accommodations.

Benefits

Open Enrollment

•  Open Enrollment Form 2013 (this form is no longer available for 2013)
  To Enroll, Change, Cancel, Add Dependents, Delete Dependents from your Medical or Dental plan. Submit between Monday, February 11, 2013 - Friday, March 8, 2013.

•  Flexible Benefits & Debit Card 2013 Open Enrollment Form
    To enroll in a Health or Dependent Care Flexible Spending Plan. Submit between Monday, February 11, 2013 - Friday, March 8, 2013.

Year Round

• New Employee or Qualifying Event Benefits Enrollment/Changes Form
  Medical, Dental, Life, AD&D, and Flexible Spending. Submit within 31 days of Hire or Qualifying Event date.
• Affidavit for adding a Spouse or Domestic Partner
  Submit within Open Enrollment, or within 31 days of Hire or Qualifying Event date.
• Remove Domestic Partner
  Submit within 31 days of Qualifying Event.
• 2013 TIAA-CREF Retirement Plan Enrollment/Changes
  You can turn in this form at any point to make changes to your retirement contributions.
•  2013 TIAA-CREF Opt-Out of Auto Enrollment
  You have 90 days from the first retirement contribution deposit to opt-out or you can opt-out before the retirement contribution is made.
  
• Voluntary Life Insurance Enrollment Form
   You can turn in this form at any point .
• Life Insurance Continuation Form
  Submit to LifeMap with 31 days of termination if portability is desired.
• Allegiance: Healthcare Flexible Spending Account Claim Form
  Submit your claim form with your receipts for reimbursement. 
• Allegiance: Dependent Care Flexible Spending Account Claim Form
  Submit your claim form with your receipts for reimbursement. 
• Sick Leave Sharing Program Pledge Card
  Volunteer to help your non-exempt colleagues.

• Sick Leave Sharing Program Request Form
  You may apply to receive additional sick leave pay after exhausting your own accrued sick leave and vacation hours due to your own serious illness.
• Application for Employee Tuition Remission
  This form should be submitted each semester.

Leave of Absence

• Leave of Absence request for Family or Medical Leave
  To take your FMLA/OFLA protected leave, please submit your request.
•  Certification from Health Care Provider for Employee’s Serious Health Condition
   Have your healthcare provider complete if you are taking time off for your own medical condition.
• Certification from Health Care Provider for Family Member’s Serious Health Condition
  Give this form to your family member’s healthcare provider to document the need to provide care.
• Certification from Health Care Provider for Serious Injury or Illness of Covered Servicemember
  Give this form to your covered servicemember’s health care provider to document the need to provide care.
  
• Fitness for Duty Form
  If applicable, have your healthcare provider complete this form at the end of your own serious health condition leave to ensure you are physically ready to return to work.

Position Changes and Additions

• Position Description Questionnaire (PDQ)
  Required to make changes to current job or to create a new position.

Performance Evaluations

• Exempt Staff Evaluation
   
• Support Staff Evaluation
  Resources, tips, and forms for a successful and helpful evaluation. 
• Performance Evaluation Tip Sheet

Exit Survey

• Click Here to take Exit survey
  (password required, please e-mail hr@lclark.edu for details)