Family
and Medical Leave Request:
|
Request
for Family or Medical Leave must be made, if practical, at
least 30 days prior to the date the requested leave is to
begin. |
Sick Leave Pool
|
The purpose of the Sick Leave Pool is to allow an eligible employee to contribute accrued sick leave to the Pool and if needed and approved, receive sick leave credit in the event that a catastrophic/emergency/life threatening illness or injury has depleted his/her personal sick leave account. A Physician’s Statement must accompany all withdrawal requests. |
| FSA Request for Reimbursement |
Request reimbursement from MedCom for the purchase of an eligible Flexible Spending Account item when your FSA card was not used. |
| Mail Order Prescription Form |
Order a three month supply of a prescribed maintenance drug through PrimeMail for the cost of a two month supply. This form may be used for either health insurance plan. |
StarHealth Advantage (BCBSFL BlueOptions):
|
Register online to report a change of address or a change in dependent status due to a qualifying event. Form submission may be used when internet access is unavailable. |
DHMO Dental (CompBenefits):
|
Report a change of address or a change in dependent status due to a qualifying event. |
PPO Dental (Florida Combined Life):
|
Register online to report a change of address or a change in dependent status due to a qualifying event. Form submission may be used when internet access is unavailable. |
VisionCare Plan (CompBenefits):
|
Report a change of address or a change in dependent status due to a qualifying event. |
Supplemental Life Insurance:
|
Employees may apply for supplemental life insurance for up to three times their annual salary (rounded to the nearest thousand). With the purchase of supplemental life insurance, employees may apply for a $25,000 policy on their spouse and a $10,000 policy on their eligible child(ren). All supplemental insurance applications require the completion of an EOI form. |
| Beneficiary Changes
|
Employees may update their beneficiary information at any time. |
| Position Reclassification |
Please make your
request for a Comprehensive Position Questionnaire (CPQ) for
possible reclassification of your position through the Human
Resources Department by contacting Bonnie Trenary at 904.632.3196. |
| Total Compensation Information |
This form must be completed
when hiring new administrative, professional and faculty personnel. It must
be submitted to HR as part of the hiring package. |
|
| Application for Faculty Credentialing |
This form is used to ensure all part-time adjunct faculty members’ credentials
are reviewed and that they meet their assigned discipline requirements. |
| Beneficiary Designation Form |
In the event of your death while you are an employee of FCCJ this form designates the disbursement of any monies that you would otherwise be entitled to receive (i.e. payroll, annual leave, sick leave etc.). You will need to list your beneficiaries in either sequential order — benefits will be paid out in the order named — or jointly — with each to receive the specified percentage you indicate. |
| Direct
Deposit Authorization |
This form is to
be completed by all full-time and regular part-time employees
to identify the Financial Institution of choice for direct
deposit of payroll checks. |
| Drug-Free
Workplace Act of 1988 |
This
form serves as notification to the employee of Board Rule
6Hx7-2.22, Drug-Free College Environment. |
| Employee Equity Information |
This optional form is used to assist in Federal/State EEO record keeping and reporting. |
| EZ Retirement Plan Enrollment Form |
This form is used to designate your retirement plan choice. |
| FRS Pension Plan Beneficiary Designation Form |
This form is used to designate beneficiaries for your FRS benefits in the event of your death if you elect option #1 on the EZ Retirement Plan Enrollment Form. |
| FRS Investment Plan Beneficiary Designation Form |
This form is used to designate beneficiaries for your FRS benefits in the event of your death if you elect option #2 on the EZ Retirement Plan Enrollment Form. |
| FRS New Employee Certification Form |
This form is to certify previous enrollment in a State of Florida Retirement Plan. |
| I-9
Form (Employment Eligibility Verification) |
This
form is used as verification of employment eligibility. |
| Loyalty
Oath |
This
form is required under Florida Statute 876.05 of any employee
of the state of Florida “to take acknowledgments of
instruments for public record in the state . . . ” |
| Part-time Multi-Purpose Form |
|
| Vacant and New Position Request Form |
The purpose of this form is to request the approval to advertise a full-time or regular part-time position. This form must be completed by the appropriate Cabinet member. |
| Recommendation
to Hire |
This
form is required any time a new employee is hired or a current
employee moves to a different position, campus or under a
different budget. This form may only be filled out
by the hiring administrator. |
Recommendation
for Part-Time Instructional Assignment |
This form is used
for hiring part-time adjuncts. |
| Reference
Check |
Use this form
when checking references on new hires. |
| Request
to Advertise |
This form is required
before a position can be advertised. Career positions are
advertised for a minimum of 15 working days and Admin/Professional/Faculty
positions are advertised for a minimum of 20 working days.
Internal Only positions are advertised for only 10 working
days. |
| Screening
Committee Composition Information |
This form is to be completed
by the screening committee chairperson. |
| Social Security Administration Form 1945 |
|
| Transcript
Release Form |
This form is used
to request official transcripts. |
| Transfer
Request |
This form is used
to request a lateral transfer. |
| Veterans
Preference |
This form describes
the conditions and is required when claiming veterans preference. |
| W-4
Tax Form (2008) |
This form is used
to designate tax withholdings from your payroll check. |
| Faculty
Evaluation Guidelines |
These are the guidelines for
completing faculty evaluation forms. |
| Evaluation
of Faculty - Adjunct |
This form is used by the administration
to evaluate the performance of adjunct faculty. |
| Evaluation
of Teaching Faculty |
This form is used by the administration
to evaluate the performance of faculty. |
| Evaluation
of Faculty - Counselor |
This form is used by the administration
to evaluate the performance of counselors. |
| Evaluation
of Faculty - Librarian |
This form is used by the administration
to evaluate the performance of librarians. |
Learning
Outcomes Enhance
Plan - A |
This form will be completed
annually by each full-time faculty member. For more information
please go to the Outcomes
Assessment page. |
Learning
Outcomes Enhance
Plan - B |
This form will be completed
annually by each full-time faculty member (after the initial
year) and will include results of the prior year’s plan,
a statement regarding how these results will be used to improve
the new plan, and a method for evaluating plan outcomes. For
more information please go to the Outcomes
Assessment page. |
| |
| Annual
Evaluation - Temporary Personnel |
This form is used by the administration
to evaluate the performance of temporary personnel. |
| Career
Performance Evaluation |
This is used for evaluating
career employees. You can complete part of the form on-line
and the comments sections will need to be completed manually
as the evaluation is taking place with the employee. |
| Pathways Academy Teachers Evaluation |
This form is to be used when evaluating Pathways Academy teachers. |
| Pathways Academy Teachers Observation |
This form is to be used in conjunction with the Pathways Academy Teachers Evaluation. |
|
| Name/Address/Telephone
Change Form |
This form is used
when an employee has a change of name/address/phone number. |
| Clearance
Form |
This form is to be completed
by all employees who are separating from the College or transferring
to another position. |
| Extra
Teaching Term Agreement |
This form is used by the campus
administrator to approve payment for FT faculty who are offered
and accept an opportunity to teach a third full term during
a contract year. |
Faculty
Calendar of Work Days
(2008–09)
|
Standard calendars of work days conform to the requirements of the collective bargaining agreement and the approved academic calendars. Note: individual revisions to these calendars are permissible to meet student and institutional need per the provisions of Article 27: Workload.
*Faculty currently teaching a Fall/Summer base workload schedule, the week of August 18 may not be counted for scheduling purposes for 2008–09. Instead, the five work days adjustment should be made in April, 2009. |
| Faculty
Workload Form |
This form is used for Faculty
personnel to determine daily working hours. |
| Request
for Change in Faculty Pay Level |
This form is to be used by
administration when a full-time faculty member has completed
an advanced degree or has completed a masters +30. |
| Pathways Academy Calendar of Work Days |
This form is required for all full-time Pathways Academy teachers to complete as verification of meeting the requirements of their contract. |
| Separation
Form |
This form is to be completed
by all employees who are separating from the College. |
| Status
Change |
This form is used
to change a Career employee from probationary status to permanent
status. |
| Work
Schedules |
This form is used
for Career, Professional and Administrative personnel to determine
daily working hours as agreed upon between employee and supervisor. |
