MISCELLANEOUS FORMS FOR HR AND PAYROLL
VA-4 W4	Change state withholding exemptions Change federal withholding exemptions
IRS Forms & Publications	Internal Revenue Service Forms & Publications
Application for Retirement	Instructions and application for retirement
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
Name and Address Change Form	Use when name or address has changed
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 for Leave Share (classified/faculty)
PayLine Demonstration User Id = 123456789 Password = 12345	Employee must review this demonstration prior to requesting a password (after direct deposit has been activated)
Direct Deposit Authorization Form	Any employee of the College must use direct deposit. Form must be completed with a voided check attached. This is optional for workstudy students.

HIRING INFORMATION
Processing Forms for Hiring or Rehiring a new Employee Adjunct Workstudy Other Employee	One of these forms must be sent to the HR Office for a new or returning employee
Forms for Completion Adjunct Wage/Student Workstudy	See above processing sheet for information necessary for completion to hire an employee. Forms are located below.

CLASSIFIED EVALUATIONS
Classified Staff EWP's and Yearly Evaluations Employee Work Profile Instructions/Employee Work Profile Probation Progress Review Needs Improvement Form Confidentiality Form and Essential Job Requriements Acknowledgement of Special Recognition and Attributes of a DSLCC Extraordinary Contributor Employee Work Profile Self-Assessment	Instructions and forms for completing Employee Work Profile to be completed within the employee's first 10 days of employment Probationary Status (3, 6 and 12 month) Must be completed during an employee's first 10 days of employment Form to acknowledge a Special Recognition - October 1 through September 30 (Must be to Human Resources by October 2nd) Must be given to employee for completion before evaluation is begun

WAGE EVALUATIONS
Wage Employee Work Profile Information Wage Confidentiality Form and Essential Job Requriements Wage Employee Evaluation Form	Must be completed within the first 10 days of employment New Hires - Must be completed within the first 10 days of employment

FACULTY EVALUATIONS
Faculty Administrative Physical Demands Teaching Faculty Physical Demands Faculty Confidentiality Form	12 month faculty completed upon hire 9 month teaching faculty completed upon hire All faculty completed upon hire

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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 Administrative Physical Demands 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. All employees except workstudy

HIRING FORMS Prcessing Form to Accompany Hiring Forms
W4 VA-4 (required by all employee)	federal withholding exemptions state withholding exemptions
Alcohol and Drug Form (required by all employees)	Employee must read and sign as part of employment
PayLine Demonstration with use of Direct Deposit 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 by all employees)	Employee must read and sign
Child Support Form (required by all employees)	Employee must read and sign (effort to collect child support payments)
I-9 Form 2 ID's required (required by all employees)	Must be submitted within three business days of hiring
Technology Security Agreement (required by all employees)	Employee must read and sign
Base Point Declaration Form (not required by student or work-study employees)	Use to declare or change a base point
Direct Deposit Authorization Form (required by all employees) Optional for workstudies	All employee's of the College must use direct deposit. Form must be completed an a voided check attached. This is optional for workstudy students.
Emergency Contact Form (required by all employees)	Person to notify in case of an emergency
Background Check	This must be done for ALL employee's

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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

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 .

MISCELLANEOUS FORMS FOR HR AND PAYROLL

INITIATE THE HIRING/INTERVIEW PROCESS

HIRING PACKETS (forms required)