Forms

Commonly Used Forms

Here are links to many of the commonly used forms at SCCCC. Click on the one you want, print it out, and complete it. All forms are PDFs unless otherwise noted. NOTE: Many forms are now accessible through the ADP Portal.

Contractor Agreement Forms

SCCCC Vendor Contract (PDF Form)

HIPAA Business Associate Agreement (PDF Form)

HIPAA Business Associate Agreement Cover Letter (Word)

Dental Insurance Forms

Delta Enrollment and Change Form

Delta Evidence of Insurability Form

Disciplinary Forms

Warning Notice

Warning Notice (Word)

Employee Evaluations

Part 1: 360 Peer Review

360 Peer Review - Supervisor Evaluation- Required (Word)

360 Peer Review - Employee Evaluation - Optional (Word)

Part 2: Self Evaluation - Required (Word)

Part 3: General Evaluation, All Employees - Required (Word)

Part 4: Select from the following list Job Specific Evaluation - Required

Administrative (Word)

Bus Driving (Word)

Cooking (Word)

Counseling (Word)

Family Services and Advocacy (Word)

Fiscal (Word)

Information Technology (Word)

Maintenance (Word)

Teachers (Word)

Part 5: Supervisor Evaluation - Supervisors & Managers - Required (Word)

Part 6: Managers Evaluation - Managers - Required (Word)

Employee Reimbursement Forms

Mileage Reimbursement Form (Note: Click "Open" when prompted. The form will open in Excel. Be sure to expand the Excel window to see both worksheets.)

Flexible Spending Account (FSA) Forms

eflex Enrollment Form

HSA Pre-Tax Deduction Authorization Form

Grievance Forms

Grievance Form Step 1

Grievance Form Step 2

Grievance Form Step 3

Health Insurance Forms

Blue Shield Enrollment Application

Blue Shield Change Form

HR Forms

Disclosure Authorization Form (Word)

Employee Separation Report (PDF)

Employee Separation Guidelines (Word)

Employee Separation Form (EDD Change of Status Form) (PDF)

Exit Interview Form (Word)

Job Description Template (Word)

Job Requisition Form (Word)

Leave of Absence Form (Word)

Medical Provider Certification Form (Word)

New Employee Orientation Form (Word)

Reference Check Form (Word)

Time Bank Donation Form

Authorization for Supervisor to Complete EzLabor Timecard

Vacation Request Form

Life Insurance Forms

Unum Beneficiary Designation Form-Group Life and Accident Insurance

Unum Voluntary Life Employee Application

Maintenance, Repairs & Safety

Maintenance & Repairs Rating Sheet

Safety Inspection Checklist (Word)

Payroll Forms

Make-up Time Form

Meal Period Waiver Form

Paper Timecard

Payroll Direct Deposit Form

On-Duty Meal Period Agreement

PDM Forms

Policy Change Request Form

Retirement Plan Forms

TIAA-Cref Salary Reduction Agreement

Vision Insurance Forms

VSP Enrollment/Declination Form

VSP Out-of-Network Claim Form

Workplace Safety

Incident Report Form

Supervisor Incident Report

Accident Causes (Word)