Forms Library

• Benefit Forms
• Payroll Forms
• Recruitment Forms
• Classified Forms
• Faculty Forms
• Part Time Faculty Forms
• Management Forms
• ADA Forms
• Leave of Absence/OFLA/FMLA Forms
• Safety Forms
• PERS Forms

Benefit Forms

• Affidavit of Domestic Partnership (.pdf)
  
  
• Classified Insurance Enrollment Form (.pdf)
  
  
• Faculty Insurance Enrollment Form (.pdf)
  
  
• Management Insurance Enrollment Form (.pdf)
  
  
• Part-Time Faculty Insurance Enrollment Form (.pdf)
  
  
• Salary Reduction Agreement - 403 (b)
  
  
• Salary Reduction Agreement - 457(b) (.doc)
• Salary Reduction Agreement - 457(b) (.pdf)
  
  
• 2017  Section 125 Enrollment form
  
  
• Section 125 Reimbursement Form
  
  
• Tuition Waiver - family (.doc)
• Tuition Waiver - family (.pdf)
  
  
• Tuition Waiver - part-time or other Qualifying Category (.doc)
• Tuition Waiver - part-time or other Qualifying Category (.pdf)

• Tuition Waiver - retired (.doc)
• Tuition Waiver - retired (.pdf)

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Payroll Forms

• Classified Annual Worksheet (.xls)
• Classified Annual Worksheet (not available in .pdf)
   
• Confidentiality Statement (.pdf)
   
• Direct Deposit (.doc)
• Direct Deposit (.pdf)
   
• Form I-9 (not available in Word)
• Form I-9 (.pdf)
   
• Form W-4 (not available in Word)
• Form W-4 (.pdf)
   
• FERPA (The Family Educational Rights and Privacy Act of 1974) Form (.pdf)
  
  
• Health Clinic Access Form (.pdf)
   
• Journal Entries (.doc)
• Journal Entries (.pdf)
   
• Part Time Statement of Appointment (.doc)
• Part Time Statement of Appointment (.pdf)
   
• Personal Information Form (.doc)
• Personal Information Form (.pdf)
   
• Personnel Action Form (.doc)
• Personnel Action Form (.pdf)
   
• Personal Cell Phone Allowance (not available in Word)
• Personal Cell Phone Allowance (.pdf)
   
• Student Worker Template (.doc)
• Student Worker Template (.pdf)
  
  
• Student Worker Consent Form (.doc)
• Student Worker Consent Form (.pdf)
  
  
• Vacation Cash Out Form for Classified and Managers (.pdf)
  
  
• Volunteer Waiver of Liability (.doc)
• Volunteer Waiver of Liability (.pdf)

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Recruitment Forms

• Employment Recommendation Form (.doc)
• Employment Recommendation Form (.pdf)
  
  
• Recruitment Process (.xls)
• Recruitment Process (.pdf)
  
  
• Recruitment Report (.doc)
• Recruitment Report (.pdf)
  
  
• Search Committee Agreement Form (.doc)
• Search Committee Agreement Form (.pdf)
  
  
• Search Committee Confidentiality Form (.doc)
• Search Committee Confidentiality Form (.pdf)
  
  
• Temporary Appointment Recommendation (.doc)
• Temporary Appointment Recommendation (.pdf)

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Classified Forms

• Classification Review Form (.doc)
• Classification Review Form (.pdf)
   
• Classified Evaluation (.doc)
• Classified Evaluation (.pdf)
   
• Classified Rating Scale Definitions (.doc)
• Classified Rating Scale Definitions (.pdf)
   
• Job Description Questionnaire (.doc)
• Job Description Questionnaire (.pdf)

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Faculty Forms

• Faculty Certification Form (doc)
• Faculty Certification Form (.pdf)
  
  
• Faculty Developmental Evaluation Checklist (.doc)
• Faculty Developmental Evaluation Checklist (.pdf)
  
  
• Faculty Evaluation handbook (.doc)
• Faculty Evaluation handbook (.pdf)
  
  
• Faculty Leave & Substitution Calculation - Article 32.6 (.xls)
• Faculty Leave & Substitution Calculation - Article 32.6 (.pdf)
  
  
• Faculty Pay Plan Change Request (.doc)
• Faculty Pay Plan Change Request (.pdf)
  
  
• Faculty Step Advancement Handbook (.doc)
• Faculty Step Advancement Handbook (.pdf)
  
  
• Full Load Equivalency (.xls)
• Full Load Equivalency (.pdf)
  
  
• Overload Form for Contracted Faculty (.doc)
• Overload Form for Contracted Faculty (pdf)
  
  
• Request for RIF report review form (.doc)
• Request for RIF report review form (.pdf)

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Part Time Faculty Forms

• Part Time Cancellation Process-Article 34.8 (.doc)
• Part Time Cancellation Process-Article 34.8 (.pdf)
   
• Part Time Faculty Evaluation Record Sheet (.doc)
• Part Time Faculty Evaluation Record Sheet (.pdf)
   
• Part Time Faculty Insurance Enrollment Form (.pdf)
   
• Part Time Placement form (.doc)
• Part Time Placement form (.pdf)
   
• Part Time Statement of Appointment (.doc)
• Part Time Statement of Appointment (.pdf)
   
• Part Time Statement of Appointment - with Fall Inservice (.doc)
• Part Time Statement of Appointment - with Fall Inservice (.pdf)
   
• Part Time Work Assignment- Article 34.2 (.doc)
• Part Time Work Assignment- Article 34.2 (.pdf)

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Management Forms

• Managers Performance Review Rating Scale Definition (.doc)
• Managers Performance Review Rating Scale Definition (.pdf)
  
  
• Performance Review Instrument (.doc)
• Performance Review Instrument (not available in .pdf) 
  
  
• Job Analysis Questionnaire (.doc)
• Job Analysis Questionnaire (.pdf)

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ADA Forms

• Medical Inquiry Form (ADA) (.doc)
• Medical Inquiry Form (ADA) (.pdf)
   
• Request for Accommodation (ADA) Form (.doc)
• Request for Accommodation (ADA) Form (.pdf)

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Leave of Absence/OFLA/FMLA Forms

• Health Care Provider Certification Form (.doc)
• Health Care Provider Certification Form (.pdf)
  
  
• Leave of Absence Request form - Unpaid Leave (.pdf)
  
  
• Leave of Absence Request form - Medical and Family Leave (.doc)
• Leave of Absence Request form - Medical and Family Leave (.pdf)
  
  
• Sick Child Leave Notification (.doc)
• Sick Child Leave Notification (.pdf)

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Safety Forms

• Employee Accident/Incident Analysis Form 
  
  
• Workers' Compensation 801 Form
  
  
• Mandatory Child Abuse Reporting FAQ

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PERS Forms

• One Time Variable Transfer: Active or Inactive Member (not available in Word)
• One Time Variable Transfer: Active or Inactive Member
   
• Designation of Beneficiary: Tier One or Tier Two Member (not available in Word)
• Designation of Beneficiary: Tier One or Tier Two Member
   
• Designation of Beneficiary: IAP (not available in Word)
• Designation of Beneficiary: IAP
   
• Estimate Request: Tier One or Tier Two Member (not available in Word)
• Estimate Request: Tier One or Tier Two Member
   
• Estimate Request: OPSRP Member (not available in Word)
• Estimate Request: OPSRP Member
  
  
• Data Verification Request (not available in Word)
• Data Verification Request

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Lane Community College is an equal opportunity/affirmative action institution.