Benefits - Open Enrollment

• 2013-2014 Anthem Blue Cross Guest Membership Program
• 2013-2014 Anthem Blue Cross HMO Chiropractic Plan Summary
• 2013-2014 Anthem Blue Cross HMO Directory of Providers
• 2013-2014 Anthem Blue Cross PPO Out of State Plan Summary
• 2013-2014 Anthem HMO Plan Summary
• 2013-2014 Anthem PPO Plan Summary
• 2013-2014 Anthem Rx Plan Summary
• 2013-2014 Benefit Rates
• 2013-2014 Delta Dental PPO Plan Summary
• 2013-2014 DeltaCare of CA Plan Summary
• 2013-2014 Dependent Eligiblity Guidelines
• 2013-2014 Guide to Your Benefits (as of 6/3/2013)
• 2013-2014 Kaiser Permanente Chiropractic Plan Summary
• 2013-2014 Medical Questionnaire for EOI
• 2013-2014 MES Plan Summary
• 2013-2014 Open Enrollment Computer Assistance Flyer
• 2013-2014 Opt-Out Medical Form
• 2013-2014 Prudential Open Enrollment Enhancement Flyer
• 2013-2014 SBCCD Voluntary Life GI Announcement
• Pharmacy Mail Order Form

Benefits Enrollment Forms

• Notice of COBRA Qualifying Event

Benefits Information

• American Fidelity - Accident Plan
• American Fidelity - Cancer Plan
• American Fidelity - Disability Plans
• Anthem Blue Cross Blue Card PPO Plan Summary - Out of State Retirees
• Delta Dental PPO EOC
• DeltaCare EOC
• DeltaCare Guide
• Dependent Eligibility Guidelines

Employment Forms

• Bilingual Stipend
• CHC Short Term Justification Request
• Classified Student Hourly Request Form
• Classified Employee Performance Report
• District Notice of Employment
• District Office, Annex, KVCR, Police - Short Term Justification Request
• EFT (Direct Deposit) Form
• Employee Reclassification Appeal Form
• Equivalency Determination Form
• Equivalency Request
• I-9 Employment Eligibility Verification Form
• Name Address Change
• Notice Of Employment
• Oath of Allegiance
• Professional Expert Request and Authorization Form
• Request for Position Change
• Request for Position Reclassification
• SBCCD Driver's Record Infomation Request
• SBVC Short Term Justification Request
• Short Term Requisition Form
• Statement of Qualifications
• Substitute Requisition Form
• Vacation/Time Off Request (PDF)
• Volunteer Service Verification

Faculty Evaluation Forms

• Form 16 B1 Initial Conference (DOC)
• Form 16 B1 Initial Conference (PDF)
• Form 16 B2 Evaluation Summary (DOC)
• Form 16 B2 Evaluation Summary (PDF)
• Form 16 B3 Recommendations for Improvement (DOC)
• Form 16 B3 Recommendations for Improvement (PDF)
• Form 16 B4 Statement of Improvement (DOC)
• Form 16 B4 Statement of Improvement (PDF)
• Form PIO1 Peer Evaluation Instructional and Online (DOC)
• Form PIO1 Peer Evaluation Instructional and Online (PDF)
• Form PNI1 Peer Evaluation Noninstructional (DOC)
• Form PNI1 Peer Evaluation Noninstructional (PDF)
• Form SIO1 Self Evaluation Instructional and Online (DOC)
• Form SIO1 Self Evaluation Instructional and Online (PDF)
• Form SNI1 Self Evaluation Noninstructional (DOC)
• Form SNI1 Self Evaluation Noninstructional (PDF)
• Student Evaluation of Classified Evaluation of Instructional and Noninstructional Faculty (PDF)
• Student Evaluation of Counselors (PDF)
• Student Evaluation of Instructional Faculty (PDF)
• Student Evaluation of Librarians (PDF)

Informational

• Academic Salary Reclassification Procedures Guidelines and Forms
• Adjunct Appointment Instructions
• FWS Online Hiring Process Tip Sheet
• Minimum Qualifications for Faculty
• Procedures for Requesting Reclassification
• SBCCD People Admin Supervisor/Manager Guide

Leave of Absence Forms

• Certificate of Health Care Provider
• Leave of Absence Application
• Leave of Absence Instructions and Forms

Leave of Absence Information

• Employee Leave of Absence Instructions
• Family Care - CSEA
• Family Care - CTA
• Medical Disability - CSEA
• Pregnancy - CSEA
• Pregnancy - CTA

Service Request Forms

• User Application

  This form is used to request a new, or changes to a, network account, voice mail account, or Datatel account. It is common for this form to be filled out by a manager/supervisor before a new employee starts at the district or one of the colleges.

Tax Forms

• 2014 W-4 Form
• California Employee's Withholding Allowance Form DE4

Workers Compensation - Employee

• Covered Employee Notification
• Instructions for Injured Worker

Workers Compensation - Providers

• FOX Occupational
• HEALTHPOINTE
• US HEALTHWORKS

Workers Compensation - Supervisor

• DWC-1
• Employee Statement
• Medical Authorization
• Supervisor Instructions
• Supervisor Statement
• Witness Statements