Forms Library

Forms Library

• Benefit Forms
• Payroll Forms
• Recruitment Forms
• Safety Forms
• Classified Forms
• Faculty Forms
• Part Time Faculty Forms
• Management Forms

Benefit Forms

• ADA Accommodation Forms
  • Medical ADA Inquiry Form for Health Care Providers (.pdf) (.doc)
  • Request for ADA Accommodation Form for Employees (.pdf) (.doc)
    
• Health Insurance Forms
  • Classified Insurance Enrollment/Change Form
    Management Insurance Enrollment/Change Form
  • Faculty Insurance Enrollment/Change Form

If enrolling a domestic partner, please also complete the OEBB Affidavit of Domestic Partnership.
If removing a domestic partner because of separation, please complete the OEBB Termination of Domestic Partnership.

• Leave of Absence and OFLA/FMLA Forms
  • Health Care Provider Certification Form - required for any medical leave of absence
  • Request for Leave of Absence Form (.pdf) (.doc)
• Life Insurance Beneficiary Designation
  • MyOEBB portal
• PERS Forms
  • Tier 1 / Tier 2 Forms
  • OPSRP Forms
  • IAP Forms
    
• Salary Reduction Agreement Forms
  • Tax Sheltered Annuities - 403(b) Deduction Authorization Form
  • Deferred Compensation - 457 Deduction Authorization Form (.pdf) (.doc)
    
• Section 125 Forms
  • Section 125 Enrollment Form (.pdf)
  • Section 125 Expense Reimbursement Form (.pdf)
    
• Tuition Waiver Forms
  • Part-time Employee Tuition Waiver Form
  • Family Tuition Waiver Form (.pdf) (.doc)
  • Retiree Tuition Waiver Form (.pdf) (.doc)

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Payroll Forms

• Classified Annual Worksheet
• Confidentiality Statement
• Direct Deposit Authorization Form (.pdf) (.doc)
• Form I-9
• Federal Form W-4
• Oregon Form W-4
• FERPA Form (The Family Educational Rights and Privacy Act of 1974)
• Journal Entries (.pdf) (.doc)
• Part Time Statement of Appointment (.pdf) (.doc)
• Personal Information Form (.pdf) (.doc)
• Personnel Action Form (.pdf) (.doc)
• Personal Cell Phone Allowance Agreement
• Student Worker Documentation Form (.pdf) (.doc)
• Student Worker Consent to Disclose - Waiver of FERPA Rights Form (.pdf) (.doc)
• Waiver of Liability Form for Volunteers (.pdf) (.doc)

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Recruitment Forms

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

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Safety Forms

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

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Classified Forms

• Classified Evaluation Forms
  • Classified Evaluation Form (.xlsx for pc) (.xlsx for mac)
    • Classified Evaluation Appendix A - Action Plan to Improve Deficient Performance (.doc)
    • Classified Evaluation Appendix B - Professional Development Plan (.doc)
  • Performance Level Guidelines
• Classification / Reclassification Process Forms
  • Classification Review Form (.pdf) (.doc)
  • Job Description Questionnaire (.pdf) (.doc)

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Faculty Forms

• Faculty Certification Form (.pdf) (.doc)
• Faculty Developmental Evaluation Forms
  • Faculty Developmental Evaluation Checklist (.pdf) (.doc)
  • Faculty Evaluation Handbook (.pdf) (.doc)
• Faculty Leave & Substitution Calculation - Article 32.6
• Faculty Pay Plan Change Request (.pdf) (.doc)
• Faculty Step Advancement Handbook (.pdf) (.doc)
• Full Load Equivalency (.pdf) (.xls)
• Request for RIF Report Review Form (.pdf) (.doc)

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Part Time Faculty Forms

• Part Time Cancellation Process - Article 34.8
• Part Time Faculty Evaluation Record Sheet (.pdf) (.doc)
• Part Time Placement Checklist Form (.pdf) (.doc)
• Part Time Statement of Appointment Form (.pdf) (.doc)
• Part Time Statement of Appointment Cover Notice w/ fall inservice (.pdf) (.doc)
• Part Time Work Assignment - Article 34.2 (.pdf) (.doc)

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Management Forms

• Managers Performance Review Rating Scale Definition
• Performance Review Instrument (.pdf)
• Job Analysis Questionnaire (.pdf) (.doc)

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