Dabney S. Lancaster Community College

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Supervisor/Employee Forms

 

Please utilize the following tables to select forms that you may need for HR/payroll changes, to initiate the hiring process, hiring packets or orientation of employees .


Return completed forms to the Human Resources Office or to someone in the Business Office.


If you have questions, please call (540) 863-2808 or email Joyce Emerson.

In order to download some of these forms, Adobe Acrobat Reader is required.

Miscellaneous Forms for HR, and Payroll

Purpose

VA-4

 

 

Change state withholding exemptions

W4

Change federal withholding exemptions

IRS Forms & Publications Internal Revenue Service Forms & Publications
Application for Retirement Instructions and application for retirement
Name and Address Change Form Use when name or address has changed
Professional Plan Development Form Use this form prior to requesting educational aid
Education Aid Request Form Use to request education aid
Salary Reduction Agreement (pre-tax deduction form) Use to request changes to annuity payments
Post-Tax Salary Deduction Authorization Use to request changes to payroll deducted insurance payments

FORMS FOR PROCESSING AN EMPLOYEE IN HR/PAYROLL

Adjunct Processing Form

Workstudy Processing Form

Other Employee Processing Form

Emloyee Processing Forms for

   1.  Adjunct Part-time Faculty

   2.  Workstudy Student

   3.  Other (student  and hourly)

CLASSIFIED STAFF

Employee Work Profile (EWP)

Employee Work Profile Instructions

Confidentiality Form and Essential Job Requriements

Acknowledgement of Special Recognition

 

Needs Improvement Form

 

Probation Progress Review

 

Employee Work Profile Self-Assessment

Attributes of a DSLCC Extraordinary Contributor

       -----------------------

       WAGE EVALUATION

Wage Confidentiality Form and Essential Job Requriements

Wage Employee Evaluation Form

WAGE EMPLOYEE WORK PROFILE INFORMATION

       -----------------------

FACULTY EVALUATIONS

Faculty Administrative Physical Demands

Teaching Faculty Physical Demands

 

Faculty Confidentiality Form

 

 

 

 

Instructions and forms for completing Employee Work Profile

 

 

 

Form to acknowledge a Special Recognition - October 1 through September 30

 

 

Probationary Status (3, 6 and 12 month)

 

Employee to complete

 

 

Dates are same as full-time

 

 

 

 

 

 

 

 

 

VCCS FOIA Request Form Freedom of Information Act
   

Salary Reduction Agreement

Pre-tax

Post-tax

Form to initialize, increase or decrease annuity amount
   

Request for Family and Medical Leave

Leave Share:

      Donor form

      Applicant request

Request Family or Medical Leave

 

Request for Leave Share (classified/faculty)

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Initiate the Hiring/Interview Process

Procedures outlining the hiring selection process
Permission to Hire Faculty/Classified Staff Permission to hire a faculty or classified staff employee
Permission to Hire Hourly Employee Hourly, Student and Tutor
Application Review Report Report justifying whether an applicant is qualified to be interviewed or qualifies as an alternate
Interview Sheet Interview sheet to be used to justify whether the interviewed candidate can/cannot perform the position as described
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Hiring Packets (forms required)

Department Payroll/HR Processing Form for Hiring an Employee

 

Proposal for New Faculty Appointment

 

Teaching Faculty Physical Demands

Faculty Confidentiality Form

Background Check  Form

 

First half of form is to be completed by the division administrative assistant or appointing authority and submitted with the hiring packet forms listed on the Processing Form 

To be completed by Dean/Vice President on each Adjunct Instructor hired.

W4

 

VA-4

Change federal withholding exemptions

Change state withholding exemptions

Alcohol and Drug Form Employee must read and sign as part of employment

PayLine Demonstration

User Id = 123456789

Password = 12345

Employee must review this demonstration prior to requesting a password (after direct deposit has been activated)
Selective Service Form (required for all employees) Employee must read and sign

Child Support Form

(required for all employees)

Employee must read and sign (effort to collect child support payments)
I-9 Form  (completed by hiring department--2 ID's required) Must be submitted within three business days of hiring
Technology Security Agreement Employee must read and sign
Base Point Declaration Form
(not required by student employees)
Use to declare or change a base point
Direct Deposit Authorization Form - (not permitted by adjunct instructors or student employees)

Use to establish pay check direct deposit

Form must be taken to prospective band for completion

Emergency Contact Form (all full-time faculty, staff and wage employees) Person to notify in case of an emergency
Computer Access Form (green form)
Human Resource Responsibility

 


 

 

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Full-Time New Employee Forms

Health Benefit Election (application)Form

Anthem Claim Form - Page 1

Anthem Claim Form - Page 2


Dental Form

Health Care Changes


Use for employee to select the health care (COVA CARE) policy desired

Flexible Reimbursement Election Form

Publications

Flexible Benefits Changes

For employee who chooses to participate in the flexible reimbursement plan

 

Virginia Employee Handbook Must read and return signed letter found inside of folder

Insurances & Annuities

 

Virginia Retirement Forms & Publications (includes VSDP, Group Life Insurance information)

Retirement Designation of Beneficiary Form

Establishing Retirement Account


For employee to designate retirement account beneficiary

Application for Optional Life Insurance from Minnesota Life Insurance Company

Optional Retirement Plan

For employee who chooses additional insurance coverage at his/her expense

For Full-time faculty only

   
Virginia Governmental Association  
Virginia Credit Union  
Grievance Procedures/Booklet  
Educational Course - Training Seminars (Training Activity) July 1 of one year to June 30 of next year All employees must complete by July 1 and return to the HR Office

Moving and Relocation Form
(Tenure of Agreement Form Required)

Tenure of Agreement Form

For employee who has approved moving and relocation expenses

Agreement by new employee to work for a specified in order to have certain moving and relocation expences reimbursed

   
 

 

   

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It is the policy of Dabney S. Lancaster Community College to promote equal opportunity in educational programs and activities, admissions and employment, without regard to race, creed, gender, national origin, disability or any other non-merit factor. For concerns or information requests pertaining to students, contact the Director of Student Services and Research (540/863-2850). For matters related to employment, contact the Human Resources Officer (540/863-2808).