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
Application Selection 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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<- back to Human Resources

<- back to the Payroll Department

<- back to Vice President for Financial and Administrative Services

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).

Supervisor/Employee Forms

Miscellaneous Forms for HR, and Payroll

Purpose

Initiate the Hiring/Interview Process

Hiring Packets (forms required)

Full-Time New Employee Forms