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Human Resources

Human Resources Forms

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New Hire or Rehire Processing Forms

Adjunct Faculty

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03a – Retirement Contribution Alternatives
Form 03b – CalSTRS Permissive Membership ES350 (Academic)
Form 03c – Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA-1945)
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570
Form 17 – Memo (Short-Term and Substitute Employees Only)

Classified Staff : Full Time

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – Application for Classified Employment, rev 09 2024
Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 03e – CalPERS Reciprocal Self-Certification Form PERS-EAMD-801
Form 03g – CalSTRS-PERS Retirement System Election
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570

Classified Staff : Hourly, Short Term, Substitutes

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – Application for Classified Employment, rev 09 2024
Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570
Form 17 – Memo (Short-Term and Substitute Employees Only)

Faculty

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03a – Retirement Contribution Alternatives
Form 03b – CalSTRS Permissive Membership ES350 (Academic)
Form 03c – Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA-1945)
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570
Form 17a – Memo Full-Time Academic Employees (Academic)

Managers, Certificated

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 03b – CalSTRS Permissive Membership ES350 (Academic)
Form 03c – Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA-1945)
Form 03g – CalSTRS-PERS Retirement System Election
Form 03h – CalSTRS Recipient Designation Form MS-0002
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570

Managers, Classified

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 03e – CalPERS Reciprocal Self-Certification Form PERS-EAMD-801
Form 03g – CalSTRS-PERS Retirement System Election
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570

Professional Experts

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out

Form – Application for Classified Employment, rev 09 2024
Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form – Request for Live Scan Service
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 03e – CalPERS Reciprocal Self-Certification Form PERS-EAMD-801
Form 03g – CalSTRS-PERS Retirement System Election
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570

Supervisors

Documents to be Reviewed

Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries

Forms to be Filled Out
- Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
- Form – Request for Live Scan Service
- Form 01 – Employee Information Form
- Form 02 – Oath of Allegiance Form
- Form 03 – Retirement Information Form
- Form 03e – CalPERS Reciprocal Self-Certification Form PERS-EAMD-801
- Form 04 – Racial-Ethnicity Background Identification Form
- Form 05 – Sexual Harassment and Non-Discrimination
- Form 06 – Serving Students with a Disability
- Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
- Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
- Form 10 – Direct Deposit Authorization
- Form 11 – I-9 Employment Eligibility Verification
- Form 12 – W-4 Employee's Withholding Allowance Certificate
- Form 12a – CA Employees Withholding Allowance Certificate DE-4
- Form 13 – Smoking, Vaping, Tobacco Notification AP 3570

All HR Forms

Citrus College Campus Map
Citrus College Freeway Map
Document 08 – New Health Insurance Marketplace Coverage Options and Your Health Coverage
Document 30 – Keenan and Associates Covered Employee Notification
Document 31 – Keenan and Associates New Hire Pamphlet
Document 32 – Student Records Directory Information and Privacy BP 5040
Document 33 – Employee Safety Guidelines Handbook
Document 34 – Workplace Violence Prevention AP 3510
Document 35 – Equal Employment Opportunity AP 7100
Document 36 – Discrimination Complaint Procedure AP 7101
Document 37 – Prohibition of Harassment Employees AP 7102
Document 38 – Sick Leave Notification (Professional Expert, Short-Term, Substitute, Student Employee)
Document 39 – Workers' Compensation Benefits and Reporting On-the-Job Injuries
Form – Application for Classified Employment, rev 09 2024
Form – Request for Live Scan Service
Form – California School Employee Tuberculosis (TB) Risk Assessment Questionnaire
Form 01 – Employee Information Form
Form 02 – Oath of Allegiance Form
Form 03 – Retirement Information Form
Form 03a – Retirement Contribution Alternatives
Form 03b – CalSTRS Permissive Membership ES350 (Academic)
Form 03c – Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA-1945)
Form 03d – CalPERS Member Action Request Form MAR-1
Form 03e – CalPERS Reciprocal Self-Certification Form PERS-EAMD-801
Form 03f – CalPERS Retired Annuitant Self-Certification Form
Form 03g – CalSTRS-PERS Retirement System Election
Form 03h – CalSTRS Recipient Designation Form MS-0002
Form 04 – Racial-Ethnicity Background Identification Form
Form 05 – Sexual Harassment and Non-Discrimination
Form 06 – Serving Students with a Disability
Form 07 – Workers' Compensation – Pre-Designation of Personal Physician
Form 09 – Statement of Agreement to Adhere to Confidentiality Policies
Form 10 – Direct Deposit Authorization
Form 11 – I-9 Employment Eligibility Verification
Form 12 – W-4 Employee's Withholding Allowance Certificate
Form 12a – CA Employees Withholding Allowance Certificate DE-4
Form 13 – Smoking, Vaping, Tobacco Notification AP 3570
Form 17 – Memo (Short-Term and Substitute Employees Only)
Form 17a – Memo Full-Time Academic Employees (Academic)
Form 17b – Memo Adjunct Employees (Academic)

Supplementary Application Forms

Human Resources Forms