NEW Instructional ESA's - Use this
fillable PDF packet, which includes ALL of the required forms below. This packet can be used
for new ESA employees who will be contributing towards STRS. To
determine if the ESA is STRS eligible, please refer to the
CalSTRS Determination page or the
Instructional ESA's page.
Professional Expert ESA's
- Use this fillable PDF packet, which includes ALL
of the required forms below. This packet is meant for new
Professional Expert ESA employees. Professional Experts will
contribute towards PARS if they are not part of an existing
Please note - Human Resources no
Non-Instructional ESA's unless they are for
Individual ESA Hiring Forms:
Address/Name Change form - to be used
when an ESA employee has a new address or name. Please do not
submit address changes through the ESA (i.e., if a new address is
used on the ESA in the employees "home address" field, it will NOT
change the address that the District has on file for them.
For name changes, please be sure that the employee includes
a copy of his/her Social Security card indicating the new name.
CalSTRS Permissive Membership Elect/Declination form
Instructional ESA's ONLY (do not use if
already a member of CalSTRS). An employee who performs
creditable service and who is excluded from mandatory membership may
elect membership in the CalSTRS Defined Benefit Program at any time
while employed to perform creditable service. If membership is
elected, then the election becomes irrevocable until employment has
been terminated. For additional information, please feel free to
e-mail Ashley Poole.
Post-Retirement Earnings Information
-all new or returning employees who have already
retired from CalSTRS should complete this form BEFORE starting work.
The purpose of this form is to ensure that the District is in
compliance with new CalSTRS regulations AND to ensure that employees
who are CalSTRS retirees are aware of the annual post-retirement
earnings limitations as set forth by CalSTRS.
- Please make a copy for the
Regulations - Give this packet to the employee.
Conflict of Interest
Rules Policy - Give this packet to the employee.
- All employees must complete this form. The information is
kept confidential and is not released to the campuses. The
demographic information is used for reporting purposes only.
- Optional (if the employee requests a
hard copy). This
is the link to the EDD department where you can print the
booklet. Or, the booklets should be available at your
campus business office.
- Please ask each new ESA
employee to complete this form so that the office of Human Resources
can have up-to-date emergency contact information. This form
should also be used if and/or when an employee wishes to change
his/her emergency contacts.
Employee Self Service Information
- Give a copy of this form to the employee. Please ask
your employee to go on-line and complete the requested
Employee FERPA Agreement Form - Please ask new ESA employees to
read, sign, and date.
Employment Eligibility Disclosure Form
and P-881 (Report of convictions - complete and submit the P-881
form only if applicable; otherwise, you may leave this form
Employment Eligibility Verification (Form I-9)
- This form is
required by law. Please follow the instructions on the
forms. Include copies of the documents used to complete
the I-9 form (i.e. social security card, drivers license,
Please submit pages 7 and 8 ONLY (in addition to the Social
Security card and
California Driver's License)
ESA employees must have their fingerprints taken. It is
acceptable for the new ESA employee to start working as soon as Human
Resources has received "proof" that the prints have been taken
(proof is the completed "Request for Live Scan Service" form). All ESAs will be approved for fingerprints
unless you hear otherwise. Fingerprint packets are
available through the division where the employee is working.
The packet also includes the required Payroll "Fingerprint
Deduction" form, which must be returned to Human Resources
(PLEASE return the original
deduction form; our Payroll Department requires "wet" signatures on
Freedom From Disabling Disease Form (Required for employees who
are retired from CalSTRS).
(List of positions that require Hep-B training and
the instructions for the training. It is up to the hiring
manager/supervisor to determine if the work being performed off of
the ESA requires Hep-B training)
Health Insurance Marketplace
Notice - This notice provides some basic information about the new
Marketplace and employment-based health coverage offered by your
Oath - Required for all School District employees.
New Employee Training Checklist -
Ask employee to complete the ENTIRE form. Please give employee the
information attached to the form. Please be sure that the person
who explains this form to the employee signs and dates the bottom of
this form in the "Hiring Representative Signature" field.
Word "Fill-able Form" or "PDF
Version" ; also, please provide the employee with a copy of the
Job Safety Analysis form.
Notice of Exclusion from CalPERS Membership
- This form should be submitted with each
new non-instructional/professional expert assignment and/or with a
break in service (no matter what length of time). The purpose of the form is to notify
the employee that the duties being performed do not qualify for
membership in CalPERS. The supervisor or hiring manager
should complete the "certifying officer" fields including the
signature, title and date).
**Note: Employees should NOT
complete this form if they are a CalSTRS member**
Notice of Workers Compensation
Give the employee his/her
portion of the packet. Please be sure that both the
employee and the supervisor sign the Workers Compensation Form
that is submitted with the new hire paperwork.
Facts About Workers'
Compensation Brochure - Effective
November, 2011, this brochure must be given to all new employees.
This brochure is in addition, not in place of, our existing Workers'
Compensation form. We will soon have a scanned version of this
brochure which will be added to this web page. Until then,
please call or e-mail Ashley
Poole at (916) 568-3179 and request a brochure for each new
ESA employee you hire. They are also available in your campus
- if applicable, see compliance checklist for additional
Plans Participation Information Form - This form is optional.
If it is easier for you to ask the employee to use this form,
instead of asking the employee to complete Question #3 on the ESA,
you may leave the question on the ESA blank and attach this
completed form instead.
Rights and Responsibilities
- Give packet to
employee. Updated each Fall and Spring semester by HR.
Social Security Card
- in accordance with Human Resources policies, a copy of the social security card
must be included with the new hire paperwork.
- Statement Concerning Your
Employment in a Job Not Covered by Social Security. This form
is applicable only to employees who contribute towards CalSTRS or
PARS; however, we request that all employees complete this form upon
hiring, even if it does not apply. Please submit only ONE copy
to Human Resources.
Statement of Mandated Reporter
- Community College employees are mandated reporters
for child abuse and/or neglect. (child abuse and neglect reporting
law, Penal Code: 11166.5)
TB clearance -
Must be on file within 15 days of the first
date of employment and every four years thereafter.
- ESA employees are required to submit timesheets
before payment can be processed. Timesheets should be kept at
the campus level. The ESA timesheet is available in the "soft
copy" format (as attached) or a hard-copy NCR form is available
through the District Office duplicating department.
W-4 Form -
Federal Withholding Allowance Certificate. Can be submitted
with, or without, the
DE-4 form (State Withholding
Allowance Certificate). Please contact the payroll department
if you have questions regarding the use of the DE-4 Form.
Note: This is the 2015 Form W-4; please recycle the older
blank W-4 forms and start using this new one, ASAP.
original tax withholding forms; our Payroll Department
requires "wet" signatures on their forms).