Employment Service Agreement - Academic (ESA)
Professional Expert Agreement (PEX)

Required Hiring Forms
Human Resources Internal Home Page

ESA Table of Contents

ESA-Academic Form

PEX Form

ESA Home Page

Ancillary Activities List


Determining What Hiring Paperwork Is Required...

Type of Employee Required Hiring Paperwork
  • Past ESA/PEX Employees without a break in service
All required paperwork should be on file
(check with Human Resources at 916-568-3179 or HR-EmployeeAgreements@losrios.edu)
  • Past ESA/PEX Employees with a break in service
Please contact Human Resources at 916-568-3179 or HR-EmployeeAgreements@losrios.edu. HR will need to review the employee's personnel file
  • First-time ESA/PEX for a current LRCCD employee without a break in service
  • SSA-1945
  • Compliance Checklist
  • Notice of Exclusion from CalPERS Membership (Required for ALL PEXs)
  • First-time ESA/PEX Employees (have never worked for Los Rios before)
(See below)

First-time ESA/PEX Employees (not current Los Rios employees):

Please submit original copies (with "wet" signatures) of the forms along with the new ESA or PEX.  Please be sure that the employee completes his/her forms in their entirety.  Please also sign all appropriate sections that the hiring supervisor and/or HR representative should sign.

Complete New Hire ESA and PEX Packets:

    New ESA Employee Hiring Packet - Use this fillable PDF packet, which includes most of the required forms below.  This packet can be used for newly hired ESA employees.  ESA work is instructional; therefore, it is considered CalSTRS creditable. 
    **If you are able to print front-to-back, please use this version of the New ESA Employee Hiring Packet**

    NEW PEX Employee Hiring Packet - Use this fillable PDF packet, which includes most of the required forms below.  This packet is meant for newly hired Professional Expert employees. Professional Experts contribute towards PARS since the work is not CalSTRS or CalPERS creditable.

    **If you are able to print front-to-back, please use this version of the New PEX Employee Hiring Packet**

    ESA/PEX Individual Hiring Forms (Use for both ESAs and PEXs):

  • 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 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.    

  • Compliance Checklist - Please make a copy for the employee. 

  • Computer Use Regulations - Give this packet to the employee.

  • Conflict of Interest Rules Policy - Give this packet to the employee.

  • Demographic form - 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.

  • EDD booklet - This is the link to the EDD department where you can print the booklet (booklet DE 2320 under the "For Your Benefit: California's Programs for the Unemployed" section).  The booklets should also be available at your campus business office.

  • Emergency Information - 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 information. 

  • Employee FERPA Agreement Form - Please ask new ESA employees to read, sign, and date.

  • Employment Eligibility Disclosure Form and P-881 if applicable (Report of convictions - complete and submit the P-881 form only if applicable; otherwise, you may leave this form blank)

  • Fingerprints - 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 also requires "wet" signatures on their forms).

  • Freedom From Disabling Disease Form (Required for employees who are retired from CalSTRS).

  • Hepatitis B - 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 employer.

  • I-9 Form - Employment Eligibility Verification (if have latest Adobe Reader software may have to download form to complete) - This form is required by law.  Please follow the instructions on the form or click here for the Handbook for Employers for more direction and examples of acceptable documentation.  Include copies of the documents used to complete the I-9 form (e.g. social security card, drivers license, passport, etc.).

  • Loyalty Oath - Required for all School District employees.

  • Mandatory Title IX Training ("Not Anymore") -  LRCCD requires that every new employee complete Title IX Mandatory Training on Violence Intervention & Prevention (Not Anymore training) within 30 days of their initial hire date.  It is required once, at the time of hire and can be completed on the Employee Self-Service page.

  • 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 appropriate Job Safety Analysis form.

  • 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.  The Worker's Compensation brochure and form are also available in your campus VPA Office.

  • Retirement 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 the Retirement Question on the ESA/PEX.

  • Rights and Responsibilities - Give packet to employee.  Updated each Fall and Spring semester by HR.

  • Social Security Card (COPY) - in accordance with Human Resources policies, a copy of the social security card must be included with the new hire paperwork.  The name on the ESA/PEX must match the employee's social security card

  • SSA-1945 - 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 (all PEXs); 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)

  • Timesheet - ESA and PEX employees are required to submit timesheets in order for payment can be processed.  Timesheets should be kept at the campus level.  The ESA/PEX 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.  PLEASE submit original tax withholding forms with "wet" signature(s).

    ESA ONLY Hiring Forms (Do not complete for PEXs):

    • CalSTRS Permissive Membership Elect/Declination form (MR350) - (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 email HR-EmployeeAgreements@losrios.edu.

    • TB Requirement - Must be on file within 15 days of the first date of employment and every four years thereafter.

    PEX ONLY Hiring Forms (Do not complete for ESAs):

    • Notice of Exclusion from CalPERS Membership - This form must be submitted each fiscal year. 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). 

    • PARS Packet -  Not required at the time of submission of PEX.  Provide to employees working on PEX so that they can complete the forms and submit them to HR.  See the compliance checklist for additional information





Los Rios Home | Employees Only | Job Openings | Contact Us