Human Resources
Forms
Pre-Employment
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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
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Would you like to update your address?
Please complete our online form. -
Personal Information Sheet
For new employees who wish to provide their contact information
Payroll
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W-2 2009 Duplicate Request
Submit this form to receive a duplicate W-2 for 2009 (Duplicates will be sent at the end of Feburary, 2010) -
Direct Deposit Enrollment
Sign up for direct deposit and electronic statements.
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Electronic Statement Enrollment
Sign up for electronic pay advices. -
Form W-4
Designate your tax withholdings. -
Pay Statement Replacement Form
To request a duplicate pay statement or advice. -
Time Sheet (Non-Exempt 2009-2010)
Record your regular hours, vacation, and sick pay. -
Time Sheet Instructions (Non-Exempt)
Some steps to complete your time sheet properly. -
Employee Absence Report (Exempt)
Record your vacation and sick days.
Accommodations
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Reasonable Accommodation Request
Assist the College in making reasonable accommodations. -
Disability Verification
Determine your eligibility for accommodations.
Benefits
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Benefits Enrollment/Changes
Medical, Dental, Life, AD&D, and Flexible Spending. Submit within 31 days of Hire or Qualifying Event date. -
Flexible Benefits & Debit Card Enrollment Form
Submit this form within 31 days of hire to enroll in a flexible spending account. -
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. -
2010 TIAA-CREF Retirement Plan Enrollment/Changes
You can turn in this form at any point to make changes to your retirement contributions. -
Voluntary Life Insurance Enrollment Form
You can turn in this form at any point . -
Personal Choice: Healthcare Flexible Spending Account Claim Form
Submit your claim form with your receipts for reimbursement. Deadline June 30, 2010. -
Personal Choice: Dependent Care Flexible Spending Account Claim Form
Submit your claim form with your receipts for reimbursement. Deadline June 30, 2010. -
Sick Leave Sharing Program Pledge Card
Volunteer to help your non-exempt colleagues.
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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.
Leave of Absence
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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.
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PHI Release of Own Health Info Form
You must authorize the disclosure of your protected health information if you are taking time off for your own condition. -
PHI Release of Dependent's Health Info Form
Your dependent must authorize the disclosure of their protected health information if you are taking time off to care for your family member. -
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
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Position Description Questionnaire (PDQ)
Required to make changes to current job or to create a new position.
Performance Evaluations
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Exempt Staff Evaluation
Due June 30th of every year. -
Support Staff Evaluation
Resources, tips, and forms for a successful and helpful evaluation. - Performance Evaluation Tip Sheet
Exit Survey
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Click Here to take Exit survey
(password required, please e-mail hr@lclark.edu for details)
Contact Us
The Office of Human Resources is located in South Chapel Annex.
email hr@lclark.edu
voice 503-768-6235
fax 503-768-6233
Director Isaac Dixon
Office of Human Resources
0615 S.W. Palatine Hill Road, MSC 72
Portland, Oregon 97219