Office Of Human Resources

Forms

Attendance Forms:
⇒  Request To Adjust Personal Day Bank
⇒  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


Annual Turn-in of Unused Sick/Vacation Days Group A, B, and C:
      ⇒ 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
⇒ Request for Carryover of Vacation Days - Group C 12 month ONLY
⇒ Vacation Day Payment Form Choices –
            • ASPPG Only
            • Confidential Employees Only
⇒ Vacation Day Payment – At Separation from LBCSD ONLY

Benefits Forms:
⇒   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

⇒ Claim Forms:
      ⇒ 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

HR Forms:
⇒  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

• 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