Human Resources - Forms

⇒  Request To Adjust Personal Day Bank
⇒  Request for Leave of Absence Form
⇒  Personal Day Request Form Group A
⇒  Personal Day Request Form Group B & C
⇒  Cancer Screening Verification Form
⇒  CTA Sick Day Request Form
⇒  CTA Sick Day Donation Form
⇒  Reason For Absence (To Be Completed By Employee) Form
⇒  Request for Leave - 12 month Employees

⇒ Classroom Teacher’s Association – Group A Form
⇒ Administrative, Supervisory and Pupil Personnel – Group B Form
⇒ Long Beach School Employees’ Association – Group C Form
⇒ Vacation Day Payout for Individual Contracts
⇒ Request for Payment for Unused Sick Days - Transportation Only
⇒ Request for Carryover of Vacation Days Form - ASPPG 12 month ONLY
⇒ Vacation Day Payment Form Choices –
            • ASPPG Only
            • Confidential Employees Only
⇒ Vacation Day Payment – At Separation from LBCSD ONLY

⇒   COBRA
⇒   EMPIRE Young Adult Option - Medical
⇒   Flexible Spending Accounts
⇒   Health Benefits Option Form
⇒   Leave of Absence Direct Pay
⇒   Life/AD&D/EMM Enrollment/Change Form
⇒   Open Enrollment (Health)
⇒   Reasonable/Workplace Accommodations
⇒   Empire Plan Summary of Benefits
⇒   Surviving Spouse/Dependent Election Form
⇒   Guardian Dependent Eligibility Certification Form

⇒ Guardian Dental Claim Form
⇒ Empire Health Insurance Claim Form
⇒ Excess Major Medical Form
⇒ Eyeglass Reimbursement Claim Form - Group A/B *NEW
⇒ Eyeglass Reimbursement Claim Form - Group C *NEW
⇒ Flex Voucher
⇒ Worker's Compensation - C2F Incident Report Form

⇒  Change of Address, Name, Telephone
⇒  Maternity Leave of Absence Request Form
⇒  FMLA Request Form
⇒  Overtime Request and Authorization
⇒  Request for Participation in Study Program - Group A
⇒  Request for Participation in Study Program - Group B
⇒  Tuition Reimbursement for Study Money

Evaluation Forms:
⇒ Classroom Observation Report - Updated 01/03/12
⇒ LBCSD - Annual Evaluation Report (Teachers)
⇒ Long Beach Public Schools - Annual Evaluation Report (Group B)

Long Beach City School District Evaluations:

• Clerical
• Dispatcher
• Food Service Worker
• Bus Aide
• Buildings and Grounds
• Aides and Teaching Assistants
• Safety Inspector
• Bus Driver
• Mechanical

  ⇒ Unsatisfactory Substitute Form

⇒ Request for Personnel (white)
⇒ Personal Interview Reaction (green)
⇒ Review of Demonstration Lesson (pink)
⇒ Confidential Telephone Reference Check (blue)
⇒ Writing Sample Rubric (white)
⇒ Personnel Application Packet Checklist (white)

• Federal Tax Form - W4
• State Tax Form - IT-2104
• Direct Deposit Form and Direct Deposit Q&A
• Pay Option Form
• Professional Field Experience Application
• ERS Beneficiary Form
• TRS Change of Beneficiary Form